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Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Transplant Or Implant Of Heart Assist System Without Mcc","code_information":[{"code":"002","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major","code_information":[{"code":"003","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.","code_information":[{"code":"004","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Liver Transplant With Mcc Or Intestinal Transplant","code_information":[{"code":"005","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Liver Transplant Without Mcc","code_information":[{"code":"006","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lung Transplant","code_information":[{"code":"007","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simultaneous Pancreas And Kidney Transplant","code_information":[{"code":"008","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone marrow transplant","code_information":[{"code":"009","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas Transplant","code_information":[{"code":"010","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc","code_information":[{"code":"011","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc","code_information":[{"code":"012","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc","code_information":[{"code":"013","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allogeneic Bone Marrow Transplant","code_information":[{"code":"014","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Autologous Bone Marrow Transplant With Cc/Mcc","code_information":[{"code":"016","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Autologous Bone Marrow Transplant Without Cc/Mcc","code_information":[{"code":"017","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies","code_information":[{"code":"018","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simultaneous Pancreas And Kidney Transplant With Hemodialysis","code_information":[{"code":"019","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc","code_information":[{"code":"020","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc","code_information":[{"code":"021","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc","code_information":[{"code":"022","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla","code_information":[{"code":"023","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc","code_information":[{"code":"024","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures With Mcc","code_information":[{"code":"025","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures With Cc","code_information":[{"code":"026","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc","code_information":[{"code":"027","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures With Mcc","code_information":[{"code":"028","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures With Cc Or Spinal Neurostimulators","code_information":[{"code":"029","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures Without Cc/Mcc","code_information":[{"code":"030","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures With Mcc","code_information":[{"code":"031","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures With Cc","code_information":[{"code":"032","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures Without Cc/Mcc","code_information":[{"code":"033","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures With Mcc","code_information":[{"code":"034","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures With Cc","code_information":[{"code":"035","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures Without Cc/Mcc","code_information":[{"code":"036","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures With Mcc","code_information":[{"code":"037","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures With Cc","code_information":[{"code":"038","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures Without Cc/Mcc","code_information":[{"code":"039","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc","code_information":[{"code":"040","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator","code_information":[{"code":"041","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc","code_information":[{"code":"042","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hyphema","code_information":[{"code":"043","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections","code_information":[{"code":"044","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neurological eye disorders","code_information":[{"code":"045","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age >17 w CC","code_information":[{"code":"046","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age >17 w/o CC","code_information":[{"code":"047","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age 0-17","code_information":[{"code":"048","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures","code_information":[{"code":"049","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sialoadenectomy","code_information":[{"code":"050","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Salivary Gland Procedures Except Sialoadenectomy","code_information":[{"code":"051","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Disorders And Injuries With Cc/Mcc","code_information":[{"code":"052","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"1 through 10","median_amount":57820.0,"10th_percentile":57820.0,"90th_percentile":57820.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Disorders And Injuries Without Cc/Mcc","code_information":[{"code":"053","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nervous System Neoplasms With Mcc","code_information":[{"code":"054","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"1 through 10","median_amount":29686.35,"10th_percentile":29686.35,"90th_percentile":29686.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nervous System Neoplasms Without Mcc","code_information":[{"code":"055","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Degenerative Nervous System Disorders With Mcc","code_information":[{"code":"056","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"1 through 10","median_amount":38957.24,"10th_percentile":38957.24,"90th_percentile":38957.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"1 through 10","median_amount":58525.77,"10th_percentile":58525.77,"90th_percentile":58525.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"1 through 10","median_amount":149379.56,"10th_percentile":149379.56,"90th_percentile":149379.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"1 through 10","median_amount":34223.01,"10th_percentile":20652.17,"90th_percentile":42271.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"1 through 10","median_amount":30400.0,"10th_percentile":30400.0,"90th_percentile":30400.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"1 through 10","median_amount":35105.0,"10th_percentile":35105.0,"90th_percentile":35105.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Degenerative Nervous System Disorders Without Mcc","code_information":[{"code":"057","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"1 through 10","median_amount":47375.0,"10th_percentile":47375.0,"90th_percentile":47375.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"1 through 10","median_amount":26600.0,"10th_percentile":26600.0,"90th_percentile":26600.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"1 through 10","median_amount":9743.92,"10th_percentile":3208.29,"90th_percentile":21567.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":38000.0,"10th_percentile":38000.0,"90th_percentile":38000.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"1 through 10","median_amount":40064.67,"10th_percentile":34047.46,"90th_percentile":115524.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"1 through 10","median_amount":108173.0,"10th_percentile":108173.0,"90th_percentile":108173.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"1 through 10","median_amount":28180.88,"10th_percentile":28180.88,"90th_percentile":28180.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"17","median_amount":27666.14,"10th_percentile":21668.79,"90th_percentile":52539.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"1 through 10","median_amount":22800.0,"10th_percentile":22800.0,"90th_percentile":22800.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":53618.51,"10th_percentile":53618.51,"90th_percentile":53618.51},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"1 through 10","median_amount":57820.0,"10th_percentile":57820.0,"90th_percentile":57820.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"1 through 10","median_amount":51625.0,"10th_percentile":51625.0,"90th_percentile":51625.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"11","median_amount":21666.04,"10th_percentile":1860.0,"90th_percentile":37480.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"1 through 10","median_amount":22362.64,"10th_percentile":16624.86,"90th_percentile":38242.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia With Mcc","code_information":[{"code":"058","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia With Cc","code_information":[{"code":"059","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"1 through 10","median_amount":79800.0,"10th_percentile":79800.0,"90th_percentile":79800.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","code_information":[{"code":"060","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"1 through 10","median_amount":27566.66,"10th_percentile":27566.66,"90th_percentile":27566.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"1 through 10","median_amount":15885.18,"10th_percentile":15885.18,"90th_percentile":15885.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc","code_information":[{"code":"061","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc","code_information":[{"code":"062","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc","code_information":[{"code":"063","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","code_information":[{"code":"064","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","code_information":[{"code":"065","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"1 through 10","median_amount":49400.0,"10th_percentile":49400.0,"90th_percentile":49400.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8263.2,"10th_percentile":8263.2,"90th_percentile":8263.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"1 through 10","median_amount":45907.25,"10th_percentile":45907.25,"90th_percentile":45907.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"1 through 10","median_amount":37282.31,"10th_percentile":37282.31,"90th_percentile":37282.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","code_information":[{"code":"066","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Precerebral Occlusion Without Infarction With Mcc","code_information":[{"code":"067","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Precerebral Occlusion Without Infarction Without Mcc","code_information":[{"code":"068","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transient Ischemia Without Thrombolytic","code_information":[{"code":"069","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders With Mcc","code_information":[{"code":"070","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders With Cc","code_information":[{"code":"071","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6886.0,"10th_percentile":6886.0,"90th_percentile":6886.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders Without Cc/Mcc","code_information":[{"code":"072","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial And Peripheral Nerve Disorders With Mcc","code_information":[{"code":"073","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial And Peripheral Nerve Disorders Without Mcc","code_information":[{"code":"074","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"1 through 10","median_amount":29296.36,"10th_percentile":29296.36,"90th_percentile":29296.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Meningitis With Cc/Mcc","code_information":[{"code":"075","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Meningitis Without Cc/Mcc","code_information":[{"code":"076","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy With Mcc","code_information":[{"code":"077","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy With Cc","code_information":[{"code":"078","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy Without Cc/Mcc","code_information":[{"code":"079","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nontraumatic Stupor And Coma With Mcc","code_information":[{"code":"080","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nontraumatic Stupor And Coma Without Mcc","code_information":[{"code":"081","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour With Mcc","code_information":[{"code":"082","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour With Cc","code_information":[{"code":"083","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","code_information":[{"code":"084","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour With Mcc","code_information":[{"code":"085","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour With Cc","code_information":[{"code":"086","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour Without Cc/Mcc","code_information":[{"code":"087","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion With Mcc","code_information":[{"code":"088","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion With Cc","code_information":[{"code":"089","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion Without Cc/Mcc","code_information":[{"code":"090","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System With Mcc","code_information":[{"code":"091","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"1 through 10","median_amount":49270.0,"10th_percentile":49270.0,"90th_percentile":49270.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"1 through 10","median_amount":77900.0,"10th_percentile":77900.0,"90th_percentile":77900.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"1 through 10","median_amount":23357.61,"10th_percentile":23357.61,"90th_percentile":23357.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"1 through 10","median_amount":104417.56,"10th_percentile":104417.56,"90th_percentile":104417.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"1 through 10","median_amount":23194.13,"10th_percentile":23194.13,"90th_percentile":23194.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"1 through 10","median_amount":83769.2,"10th_percentile":83769.2,"90th_percentile":436563.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System With Cc","code_information":[{"code":"092","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"1 through 10","median_amount":30320.0,"10th_percentile":30320.0,"90th_percentile":30320.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"1 through 10","median_amount":32215.0,"10th_percentile":32215.0,"90th_percentile":32215.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"1 through 10","median_amount":68400.0,"10th_percentile":68400.0,"90th_percentile":68400.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"1 through 10","median_amount":24340.26,"10th_percentile":24340.26,"90th_percentile":24340.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"1 through 10","median_amount":202569.5,"10th_percentile":202569.5,"90th_percentile":202569.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"1 through 10","median_amount":50490.31,"10th_percentile":50490.31,"90th_percentile":50490.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Other Disorders Of Nervous System Without Cc/Mcc","code_information":[{"code":"093","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Mcc","code_information":[{"code":"094","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"1 through 10","median_amount":44843.23,"10th_percentile":44843.23,"90th_percentile":44843.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Cc","code_information":[{"code":"095","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"1 through 10","median_amount":13729.28,"10th_percentile":13729.28,"90th_percentile":13729.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","code_information":[{"code":"096","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc","code_information":[{"code":"097","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","code_information":[{"code":"098","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","code_information":[{"code":"099","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"1 through 10","median_amount":15706.93,"10th_percentile":15706.93,"90th_percentile":15706.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Seizures With Mcc","code_information":[{"code":"100","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"1 through 10","median_amount":97219.01,"10th_percentile":97219.01,"90th_percentile":97219.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"1 through 10","median_amount":22098.2,"10th_percentile":22098.2,"90th_percentile":22098.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Seizures Without Mcc","code_information":[{"code":"101","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4682.48,"10th_percentile":4682.48,"90th_percentile":4682.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Headaches With Mcc","code_information":[{"code":"102","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Headaches Without Mcc","code_information":[{"code":"103","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath","code_information":[{"code":"104","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath","code_information":[{"code":"105","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass w PTCA","code_information":[{"code":"106","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"107","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures","code_information":[{"code":"108","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"109","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Cardiovascular Procedures w CC","code_information":[{"code":"110","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Cardiovascular Procedures w/o CC","code_information":[{"code":"111","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"112","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Orbital Procedures With Cc/Mcc","code_information":[{"code":"113","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Orbital Procedures Without Cc/Mcc","code_information":[{"code":"114","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extraocular Procedures Except Orbit","code_information":[{"code":"115","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intraocular Procedures With Cc/Mcc","code_information":[{"code":"116","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intraocular Procedures Without Cc/Mcc","code_information":[{"code":"117","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement","code_information":[{"code":"118","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vein ligation & stripping","code_information":[{"code":"119","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other circulatory system O.R. procedures","code_information":[{"code":"120","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections With Cc/Mcc","code_information":[{"code":"121","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections Without Cc/Mcc","code_information":[{"code":"122","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neurological Eye Disorders","code_information":[{"code":"123","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"1 through 10","median_amount":66499.32,"10th_percentile":66499.32,"90th_percentile":66499.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of The Eye With Mcc Or Thrombolytic Agent","code_information":[{"code":"124","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of The Eye Without Mcc","code_information":[{"code":"125","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute & Subacute Endocarditis","code_information":[{"code":"126","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure & Shock","code_information":[{"code":"127","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis","code_information":[{"code":"128","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures W Cc/Mcc Or Major Device","code_information":[{"code":"129","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures W/O Cc/Mcc","code_information":[{"code":"130","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial/Facial Procedures W Cc/Mcc","code_information":[{"code":"131","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial/Facial Procedures W/O Cc/Mcc","code_information":[{"code":"132","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc","code_information":[{"code":"133","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc","code_information":[{"code":"134","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sinus And Mastoid Procedures With Cc/Mcc","code_information":[{"code":"135","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sinus And Mastoid Procedures Without Cc/Mcc","code_information":[{"code":"136","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures With Cc/Mcc","code_information":[{"code":"137","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures Without Cc/Mcc","code_information":[{"code":"138","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Salivary Gland Procedures","code_information":[{"code":"139","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures With Mcc","code_information":[{"code":"140","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures With Cc","code_information":[{"code":"141","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures Without Cc/Mcc","code_information":[{"code":"142","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc","code_information":[{"code":"143","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc","code_information":[{"code":"144","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc","code_information":[{"code":"145","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy With Mcc","code_information":[{"code":"146","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy With Cc","code_information":[{"code":"147","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc","code_information":[{"code":"148","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dysequilibrium","code_information":[{"code":"149","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Epistaxis With Mcc","code_information":[{"code":"150","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Epistaxis Without Mcc","code_information":[{"code":"151","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Otitis Media And Uri With Mcc","code_information":[{"code":"152","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Otitis Media And Uri Without Mcc","code_information":[{"code":"153","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc","code_information":[{"code":"154","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses With Cc","code_information":[{"code":"155","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc","code_information":[{"code":"156","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases With Mcc","code_information":[{"code":"157","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases With Cc","code_information":[{"code":"158","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases Without Cc/Mcc","code_information":[{"code":"159","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC","code_information":[{"code":"160","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal & Femoral Hernia Procedures Age >17 w CC","code_information":[{"code":"161","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal & Femoral Hernia Procedures Age >17 w/o CC","code_information":[{"code":"162","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures With Mcc","code_information":[{"code":"163","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures With Cc","code_information":[{"code":"164","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures Without Cc/Mcc","code_information":[{"code":"165","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures With Mcc","code_information":[{"code":"166","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"1 through 10","median_amount":95000.0,"10th_percentile":95000.0,"90th_percentile":95000.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures With Cc","code_information":[{"code":"167","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"168","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures w/o CC","code_information":[{"code":"169","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures w/o CC","code_information":[{"code":"171","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","code_information":[{"code":"173","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"G.I. hemorrhage w CC","code_information":[{"code":"174","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","code_information":[{"code":"175","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Embolism Without Mcc","code_information":[{"code":"176","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations With Mcc","code_information":[{"code":"177","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations With Cc","code_information":[{"code":"178","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations Without Cc/Mcc","code_information":[{"code":"179","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms With Mcc","code_information":[{"code":"180","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms With Cc","code_information":[{"code":"181","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms Without Cc/Mcc","code_information":[{"code":"182","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma With Mcc","code_information":[{"code":"183","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma With Cc","code_information":[{"code":"184","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma Without Cc/Mcc","code_information":[{"code":"185","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion With Mcc","code_information":[{"code":"186","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion With Cc","code_information":[{"code":"187","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion Without Cc/Mcc","code_information":[{"code":"188","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Edema And Respiratory Failure","code_information":[{"code":"189","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"1 through 10","median_amount":41147.74,"10th_percentile":41147.74,"90th_percentile":43262.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"1 through 10","median_amount":41800.0,"10th_percentile":26600.0,"90th_percentile":43700.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Mcc","code_information":[{"code":"190","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Cc","code_information":[{"code":"191","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","code_information":[{"code":"192","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy With Mcc","code_information":[{"code":"193","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy With Cc","code_information":[{"code":"194","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy Without Cc/Mcc","code_information":[{"code":"195","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease With Mcc","code_information":[{"code":"196","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease With Cc","code_information":[{"code":"197","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease Without Cc/Mcc","code_information":[{"code":"198","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax With Mcc","code_information":[{"code":"199","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax With Cc","code_information":[{"code":"200","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax Without Cc/Mcc","code_information":[{"code":"201","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bronchitis And Asthma With Cc/Mcc","code_information":[{"code":"202","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bronchitis And Asthma Without Cc/Mcc","code_information":[{"code":"203","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Signs And Symptoms","code_information":[{"code":"204","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System Diagnoses With Mcc","code_information":[{"code":"205","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System Diagnoses Without Mcc","code_information":[{"code":"206","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory System Diagnosis With Ventilator Support >96 Hours","code_information":[{"code":"207","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"1 through 10","median_amount":81757.33,"10th_percentile":81757.33,"90th_percentile":81757.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"1 through 10","median_amount":80114.85,"10th_percentile":65546.23,"90th_percentile":94510.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"1 through 10","median_amount":43700.0,"10th_percentile":32300.0,"90th_percentile":62700.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"1 through 10","median_amount":45600.0,"10th_percentile":30400.0,"90th_percentile":70300.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"1 through 10","median_amount":52917.5,"10th_percentile":52917.5,"90th_percentile":52917.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"1 through 10","median_amount":32158.0,"10th_percentile":32158.0,"90th_percentile":32158.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"1 through 10","median_amount":80413.47,"10th_percentile":47100.0,"90th_percentile":99885.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Respiratory System Diagnosis With Ventilator Support <=96 Hours","code_information":[{"code":"208","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"1 through 10","median_amount":13300.0,"10th_percentile":13300.0,"90th_percentile":13300.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complex Aortic Arch Procedures","code_information":[{"code":"209","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip & Femur Procedures Except Major Joint Age >17 w CC","code_information":[{"code":"210","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip & Femur Procedures Except Major Joint Age >17 w/o CC","code_information":[{"code":"211","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concomitant Aortic And Mitral Valve Procedures","code_information":[{"code":"212","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Abdominal Aorta With Iliac Branch Procedures","code_information":[{"code":"213","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"214","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Heart Assist System Implant","code_information":[{"code":"215","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc","code_information":[{"code":"216","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc","code_information":[{"code":"217","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc","code_information":[{"code":"218","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc","code_information":[{"code":"219","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc","code_information":[{"code":"220","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M","code_information":[{"code":"221","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc","code_information":[{"code":"222","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc","code_information":[{"code":"223","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc","code_information":[{"code":"224","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc","code_information":[{"code":"225","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc","code_information":[{"code":"226","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc","code_information":[{"code":"227","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures With Mcc","code_information":[{"code":"228","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures Without Mcc","code_information":[{"code":"229","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other cardiothoracic procedures w/o CC/MCC","code_information":[{"code":"230","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Ptca With Mcc","code_information":[{"code":"231","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Ptca Without Mcc","code_information":[{"code":"232","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc","code_information":[{"code":"233","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc","code_information":[{"code":"234","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass Without Cardiac Catheterization With Mcc","code_information":[{"code":"235","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass Without Cardiac Catheterization Without Mcc","code_information":[{"code":"236","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major cardiovasc procedures w MCC","code_information":[{"code":"237","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major cardiovasc procedures w/o MCC","code_information":[{"code":"238","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc","code_information":[{"code":"239","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc","code_information":[{"code":"240","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc","code_information":[{"code":"241","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant With Mcc","code_information":[{"code":"242","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant With Cc","code_information":[{"code":"243","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","code_information":[{"code":"244","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aicd Generator Procedures","code_information":[{"code":"245","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","code_information":[{"code":"246","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc","code_information":[{"code":"247","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","code_information":[{"code":"248","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc","code_information":[{"code":"249","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc","code_information":[{"code":"250","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","code_information":[{"code":"251","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures With Mcc","code_information":[{"code":"252","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures With Cc","code_information":[{"code":"253","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures Without Cc/Mcc","code_information":[{"code":"254","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc","code_information":[{"code":"255","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders With Cc","code_information":[{"code":"256","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc","code_information":[{"code":"257","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement With Mcc","code_information":[{"code":"258","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement Without Mcc","code_information":[{"code":"259","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement With Mcc","code_information":[{"code":"260","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement With Cc","code_information":[{"code":"261","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc","code_information":[{"code":"262","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vein Ligation And Stripping","code_information":[{"code":"263","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System O.R. Procedures","code_information":[{"code":"264","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aicd Lead Procedures","code_information":[{"code":"265","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc","code_information":[{"code":"266","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","code_information":[{"code":"267","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc","code_information":[{"code":"268","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","code_information":[{"code":"269","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures With Mcc","code_information":[{"code":"270","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures With Cc","code_information":[{"code":"271","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures Without Cc/Mcc","code_information":[{"code":"272","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous And Other Intracardiac Procedures With Mcc","code_information":[{"code":"273","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous And Other Intracardiac Procedures Without Mcc","code_information":[{"code":"274","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","code_information":[{"code":"275","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator","code_information":[{"code":"276","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Mcc","code_information":[{"code":"277","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc","code_information":[{"code":"278","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc","code_information":[{"code":"279","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Mcc","code_information":[{"code":"280","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Cc","code_information":[{"code":"281","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","code_information":[{"code":"282","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"1 through 10","median_amount":13300.0,"10th_percentile":13300.0,"90th_percentile":13300.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired With Mcc","code_information":[{"code":"283","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired With Cc","code_information":[{"code":"284","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired Without Cc/Mcc","code_information":[{"code":"285","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","code_information":[{"code":"286","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc","code_information":[{"code":"287","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis With Mcc","code_information":[{"code":"288","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis With Cc","code_information":[{"code":"289","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis Without Cc/Mcc","code_information":[{"code":"290","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock With Mcc","code_information":[{"code":"291","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"1 through 10","median_amount":24049.07,"10th_percentile":24049.07,"90th_percentile":24049.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock With Cc","code_information":[{"code":"292","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"1 through 10","median_amount":36005.0,"10th_percentile":36005.0,"90th_percentile":36005.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"1 through 10","median_amount":87011.17,"10th_percentile":87011.17,"90th_percentile":87011.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"1 through 10","median_amount":11400.0,"10th_percentile":11400.0,"90th_percentile":11400.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock Without Cc/Mcc","code_information":[{"code":"293","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis With Cc/Mcc","code_information":[{"code":"294","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis Without Cc/Mcc","code_information":[{"code":"295","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained With Mcc","code_information":[{"code":"296","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained With Cc","code_information":[{"code":"297","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained Without Cc/Mcc","code_information":[{"code":"298","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders With Mcc","code_information":[{"code":"299","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"1 through 10","median_amount":34617.54,"10th_percentile":34617.54,"90th_percentile":34617.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders With Cc","code_information":[{"code":"300","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders Without Cc/Mcc","code_information":[{"code":"301","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Atherosclerosis With Mcc","code_information":[{"code":"302","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Atherosclerosis Without Mcc","code_information":[{"code":"303","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertension With Mcc","code_information":[{"code":"304","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertension Without Mcc","code_information":[{"code":"305","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Congenital And Valvular Disorders With Mcc","code_information":[{"code":"306","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Congenital And Valvular Disorders Without Mcc","code_information":[{"code":"307","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Mcc","code_information":[{"code":"308","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"1 through 10","median_amount":56569.94,"10th_percentile":56569.94,"90th_percentile":56569.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Cc","code_information":[{"code":"309","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","code_information":[{"code":"310","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Angina Pectoris","code_information":[{"code":"311","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Syncope And Collapse","code_information":[{"code":"312","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chest Pain","code_information":[{"code":"313","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses With Mcc","code_information":[{"code":"314","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"1 through 10","median_amount":41800.0,"10th_percentile":41800.0,"90th_percentile":41800.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses With Cc","code_information":[{"code":"315","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses Without Cc/Mcc","code_information":[{"code":"316","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concomitant Left Atrial Appendage Closure And Cardiac Ablation","code_information":[{"code":"317","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy Without Intraluminal Device","code_information":[{"code":"318","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endovascular Cardiac Valve Procedures With Mcc","code_information":[{"code":"319","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endovascular Cardiac Valve Procedures Without Mcc","code_information":[{"code":"320","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","code_information":[{"code":"321","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","code_information":[{"code":"322","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","code_information":[{"code":"323","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc","code_information":[{"code":"324","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy Without Intraluminal Device","code_information":[{"code":"325","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Mcc","code_information":[{"code":"326","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Cc","code_information":[{"code":"327","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc","code_information":[{"code":"328","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures With Mcc","code_information":[{"code":"329","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures With Cc","code_information":[{"code":"330","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"331","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection With Mcc","code_information":[{"code":"332","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection With Cc","code_information":[{"code":"333","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection Without Cc/Mcc","code_information":[{"code":"334","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis With Mcc","code_information":[{"code":"335","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis With Cc","code_information":[{"code":"336","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis Without Cc/Mcc","code_information":[{"code":"337","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis With Mcc","code_information":[{"code":"338","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis With Cc","code_information":[{"code":"339","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"340","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis With Mcc","code_information":[{"code":"341","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis With Cc","code_information":[{"code":"342","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"343","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures With Mcc","code_information":[{"code":"344","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures With Cc","code_information":[{"code":"345","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"346","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures With Mcc","code_information":[{"code":"347","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures With Cc","code_information":[{"code":"348","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures Without Cc/Mcc","code_information":[{"code":"349","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures With Mcc","code_information":[{"code":"350","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures With Cc","code_information":[{"code":"351","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures Without Cc/Mcc","code_information":[{"code":"352","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral With Mcc","code_information":[{"code":"353","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral With Cc","code_information":[{"code":"354","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","code_information":[{"code":"355","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures With Mcc","code_information":[{"code":"356","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures With Cc","code_information":[{"code":"357","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"358","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc","code_information":[{"code":"359","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc","code_information":[{"code":"360","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopy & Incisional Tubal Interruption","code_information":[{"code":"361","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endoscopic Tubal Interruption","code_information":[{"code":"362","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization & Radio-Implant, for Malignancy","code_information":[{"code":"363","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization Except for Malignancy","code_information":[{"code":"364","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures","code_information":[{"code":"365","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, female reproductive system w CC","code_information":[{"code":"366","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System w/o CC","code_information":[{"code":"367","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders With Mcc","code_information":[{"code":"368","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders With Cc","code_information":[{"code":"369","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders Without Cc/Mcc","code_information":[{"code":"370","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","code_information":[{"code":"371","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"1 through 10","median_amount":24700.0,"10th_percentile":24700.0,"90th_percentile":24700.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","code_information":[{"code":"372","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","code_information":[{"code":"373","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy With Mcc","code_information":[{"code":"374","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy With Cc","code_information":[{"code":"375","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy Without Cc/Mcc","code_information":[{"code":"376","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage With Mcc","code_information":[{"code":"377","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage With Cc","code_information":[{"code":"378","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage Without Cc/Mcc","code_information":[{"code":"379","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer With Mcc","code_information":[{"code":"380","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer With Cc","code_information":[{"code":"381","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer Without Cc/Mcc","code_information":[{"code":"382","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uncomplicated Peptic Ulcer With Mcc","code_information":[{"code":"383","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uncomplicated Peptic Ulcer Without Mcc","code_information":[{"code":"384","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease With Mcc","code_information":[{"code":"385","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"1 through 10","median_amount":29442.15,"10th_percentile":29442.15,"90th_percentile":29442.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease With Cc","code_information":[{"code":"386","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease Without Cc/Mcc","code_information":[{"code":"387","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction With Mcc","code_information":[{"code":"388","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction With Cc","code_information":[{"code":"389","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction Without Cc/Mcc","code_information":[{"code":"390","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","code_information":[{"code":"391","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"1 through 10","median_amount":49400.0,"10th_percentile":49400.0,"90th_percentile":49400.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","code_information":[{"code":"392","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses With Mcc","code_information":[{"code":"393","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses With Cc","code_information":[{"code":"394","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"1 through 10","median_amount":18840.0,"10th_percentile":18840.0,"90th_percentile":18840.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Other Digestive System Diagnoses Without Cc/Mcc","code_information":[{"code":"395","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders Age 0-17","code_information":[{"code":"396","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures With Mcc","code_information":[{"code":"397","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures With Cc","code_information":[{"code":"398","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures Without Cc/Mcc","code_information":[{"code":"399","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"400","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & non-acute leukemia w other O.R. proc w CC","code_information":[{"code":"401","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical","code_information":[{"code":"402","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & non-acute leukemia w CC","code_information":[{"code":"403","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & Non-Acute Leukemia w/o CC","code_information":[{"code":"404","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures With Mcc","code_information":[{"code":"405","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures With Cc","code_information":[{"code":"406","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures Without Cc/Mcc","code_information":[{"code":"407","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc","code_information":[{"code":"408","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc","code_information":[{"code":"409","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc","code_information":[{"code":"410","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. With Mcc","code_information":[{"code":"411","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. With Cc","code_information":[{"code":"412","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. Without Cc/Mcc","code_information":[{"code":"413","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc","code_information":[{"code":"414","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. With Cc","code_information":[{"code":"415","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc","code_information":[{"code":"416","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","code_information":[{"code":"417","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Cc","code_information":[{"code":"418","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc","code_information":[{"code":"419","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures With Mcc","code_information":[{"code":"420","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures With Cc","code_information":[{"code":"421","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures Without Cc/Mcc","code_information":[{"code":"422","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc","code_information":[{"code":"423","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures With Cc","code_information":[{"code":"424","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc","code_information":[{"code":"425","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made","code_information":[{"code":"426","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc","code_information":[{"code":"427","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc","code_information":[{"code":"428","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Cervical Spinal Fusion With Mcc","code_information":[{"code":"429","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc","code_information":[{"code":"430","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Childhood Mental Disorders","code_information":[{"code":"431","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Mcc","code_information":[{"code":"432","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Cc","code_information":[{"code":"433","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"434","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Mcc","code_information":[{"code":"435","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Cc","code_information":[{"code":"436","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc","code_information":[{"code":"437","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy With Mcc","code_information":[{"code":"438","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy With Cc","code_information":[{"code":"439","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","code_information":[{"code":"440","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"1 through 10","median_amount":60612.24,"10th_percentile":60612.24,"90th_percentile":60612.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","code_information":[{"code":"441","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc","code_information":[{"code":"442","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"443","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"1 through 10","median_amount":24600.0,"10th_percentile":24600.0,"90th_percentile":24600.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract With Mcc","code_information":[{"code":"444","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract With Cc","code_information":[{"code":"445","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract Without Cc/Mcc","code_information":[{"code":"446","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody","code_information":[{"code":"447","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"448","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning & toxic Effects of Drugs Age >17 w CC","code_information":[{"code":"449","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F","code_information":[{"code":"450","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"451","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications of treatment w CC","code_information":[{"code":"452","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion With Mcc","code_information":[{"code":"453","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion With Cc","code_information":[{"code":"454","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc","code_information":[{"code":"455","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"456","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"457","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"458","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Mcc","code_information":[{"code":"459","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"460","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc","code_information":[{"code":"461","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc","code_information":[{"code":"462","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"463","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"1 through 10","median_amount":74100.0,"10th_percentile":74100.0,"90th_percentile":74100.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"464","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"465","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement With Mcc","code_information":[{"code":"466","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement With Cc","code_information":[{"code":"467","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement Without Cc/Mcc","code_information":[{"code":"468","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl","code_information":[{"code":"469","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","code_information":[{"code":"470","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion With Mcc","code_information":[{"code":"471","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion With Cc","code_information":[{"code":"472","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion Without Cc/Mcc","code_information":[{"code":"473","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc","code_information":[{"code":"474","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc","code_information":[{"code":"475","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc","code_information":[{"code":"476","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"477","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue With Cc","code_information":[{"code":"478","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc","code_information":[{"code":"479","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint With Mcc","code_information":[{"code":"480","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint With Cc","code_information":[{"code":"481","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","code_information":[{"code":"482","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Joint Or Limb Reattachment Procedures Of Upper Extremities","code_information":[{"code":"483","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major joint & limb reattachment proc of upper extremity w/o CC/MCC","code_information":[{"code":"484","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection With Mcc","code_information":[{"code":"485","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection With Cc","code_information":[{"code":"486","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc","code_information":[{"code":"487","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc","code_information":[{"code":"488","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","code_information":[{"code":"489","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim","code_information":[{"code":"490","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back & neck proc exc spinal fusion w/o CC/MCC","code_information":[{"code":"491","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc","code_information":[{"code":"492","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc","code_information":[{"code":"493","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc","code_information":[{"code":"494","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc","code_information":[{"code":"495","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc","code_information":[{"code":"496","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc","code_information":[{"code":"497","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc","code_information":[{"code":"498","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc","code_information":[{"code":"499","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures With Mcc","code_information":[{"code":"500","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures With Cc","code_information":[{"code":"501","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures Without Cc/Mcc","code_information":[{"code":"502","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures With Mcc","code_information":[{"code":"503","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures With Cc","code_information":[{"code":"504","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures Without Cc/Mcc","code_information":[{"code":"505","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Thumb Or Joint Procedures","code_information":[{"code":"506","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Shoulder Or Elbow Joint Procedures With Cc/Mcc","code_information":[{"code":"507","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc","code_information":[{"code":"508","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Arthroscopy","code_information":[{"code":"509","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc","code_information":[{"code":"510","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc","code_information":[{"code":"511","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","code_information":[{"code":"512","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","code_information":[{"code":"513","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc","code_information":[{"code":"514","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc","code_information":[{"code":"515","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc","code_information":[{"code":"516","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc","code_information":[{"code":"517","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator","code_information":[{"code":"518","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion With Cc","code_information":[{"code":"519","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc","code_information":[{"code":"520","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","code_information":[{"code":"521","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","code_information":[{"code":"522","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC","code_information":[{"code":"523","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transient ischemia","code_information":[{"code":"524","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other heart assist system implant","code_information":[{"code":"525","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"526","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"527","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Proc w Pdx Hemorrhage","code_information":[{"code":"528","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular shunt procedures w CC","code_information":[{"code":"529","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures w/o CC","code_information":[{"code":"530","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures w CC","code_information":[{"code":"531","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures w/o CC","code_information":[{"code":"532","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Femur With Mcc","code_information":[{"code":"533","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Femur Without Mcc","code_information":[{"code":"534","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Hip And Pelvis With Mcc","code_information":[{"code":"535","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Hip And Pelvis Without Mcc","code_information":[{"code":"536","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc","code_information":[{"code":"537","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc","code_information":[{"code":"538","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis With Mcc","code_information":[{"code":"539","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"1 through 10","median_amount":26600.0,"10th_percentile":26600.0,"90th_percentile":26600.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"1 through 10","median_amount":58900.0,"10th_percentile":58900.0,"90th_percentile":66500.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis With Cc","code_information":[{"code":"540","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis Without Cc/Mcc","code_information":[{"code":"541","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc","code_information":[{"code":"542","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc","code_information":[{"code":"543","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc","code_information":[{"code":"544","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders With Mcc","code_information":[{"code":"545","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders With Cc","code_information":[{"code":"546","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders Without Cc/Mcc","code_information":[{"code":"547","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis With Mcc","code_information":[{"code":"548","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis With Cc","code_information":[{"code":"549","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis Without Cc/Mcc","code_information":[{"code":"550","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Medical Back Problems With Mcc","code_information":[{"code":"551","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"1 through 10","median_amount":7507.56,"10th_percentile":7507.56,"90th_percentile":7507.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Medical Back Problems Without Mcc","code_information":[{"code":"552","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"1 through 10","median_amount":53564.48,"10th_percentile":53564.48,"90th_percentile":53564.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"1 through 10","median_amount":50836.81,"10th_percentile":50836.81,"90th_percentile":50836.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone Diseases And Arthropathies With Mcc","code_information":[{"code":"553","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone Diseases And Arthropathies Without Mcc","code_information":[{"code":"554","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"555","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc","code_information":[{"code":"556","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tendonitis, Myositis And Bursitis With Mcc","code_information":[{"code":"557","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"1 through 10","median_amount":39900.0,"10th_percentile":39900.0,"90th_percentile":39900.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tendonitis, Myositis And Bursitis Without Mcc","code_information":[{"code":"558","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"1 through 10","median_amount":38000.0,"10th_percentile":38000.0,"90th_percentile":38000.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"559","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"1 through 10","median_amount":45685.08,"10th_percentile":45685.08,"90th_percentile":45685.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"1 through 10","median_amount":173266.92,"10th_percentile":173266.92,"90th_percentile":173266.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Cc","code_information":[{"code":"560","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"1 through 10","median_amount":98800.0,"10th_percentile":98800.0,"90th_percentile":98800.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"1 through 10","median_amount":37887.7,"10th_percentile":37887.7,"90th_percentile":37887.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"1 through 10","median_amount":64781.75,"10th_percentile":64781.75,"90th_percentile":64781.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"1 through 10","median_amount":96477.59,"10th_percentile":96477.59,"90th_percentile":96477.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"1 through 10","median_amount":60800.0,"10th_percentile":60800.0,"90th_percentile":60800.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"1 through 10","median_amount":57000.0,"10th_percentile":57000.0,"90th_percentile":57000.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"1 through 10","median_amount":23922.48,"10th_percentile":23922.48,"90th_percentile":24724.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","code_information":[{"code":"561","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"1 through 10","median_amount":24635.0,"10th_percentile":24635.0,"90th_percentile":24635.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"1 through 10","median_amount":17100.0,"10th_percentile":17100.0,"90th_percentile":17100.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"1 through 10","median_amount":5821.43,"10th_percentile":5821.43,"90th_percentile":5821.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8814.08,"10th_percentile":8814.08,"90th_percentile":8814.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"1 through 10","median_amount":52386.55,"10th_percentile":52386.55,"90th_percentile":52386.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"1 through 10","median_amount":32570.65,"10th_percentile":32570.65,"90th_percentile":32570.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"1 through 10","median_amount":21148.78,"10th_percentile":21148.78,"90th_percentile":21148.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"1 through 10","median_amount":40881.89,"10th_percentile":40881.89,"90th_percentile":40881.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc","code_information":[{"code":"562","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc","code_information":[{"code":"563","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc","code_information":[{"code":"564","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","code_information":[{"code":"565","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","code_information":[{"code":"566","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx","code_information":[{"code":"567","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx","code_information":[{"code":"568","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small & Large Bowel Procedures w CC w Major Gi Dx","code_information":[{"code":"569","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement With Mcc","code_information":[{"code":"570","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement With Cc","code_information":[{"code":"571","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement Without Cc/Mcc","code_information":[{"code":"572","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis With Mcc","code_information":[{"code":"573","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis With Cc","code_information":[{"code":"574","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc","code_information":[{"code":"575","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc","code_information":[{"code":"576","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis With Cc","code_information":[{"code":"577","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc","code_information":[{"code":"578","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc","code_information":[{"code":"579","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc","code_information":[{"code":"580","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc","code_information":[{"code":"581","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mastectomy For Malignancy With Cc/Mcc","code_information":[{"code":"582","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mastectomy For Malignancy Without Cc/Mcc","code_information":[{"code":"583","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc","code_information":[{"code":"584","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc","code_information":[{"code":"585","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers With Mcc","code_information":[{"code":"592","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers With Cc","code_information":[{"code":"593","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"1 through 10","median_amount":64600.0,"10th_percentile":64600.0,"90th_percentile":64600.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers Without Cc/Mcc","code_information":[{"code":"594","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Skin Disorders With Mcc","code_information":[{"code":"595","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Skin Disorders Without Mcc","code_information":[{"code":"596","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"1 through 10","median_amount":58900.0,"10th_percentile":58900.0,"90th_percentile":58900.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders With Mcc","code_information":[{"code":"597","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders With Cc","code_information":[{"code":"598","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders Without Cc/Mcc","code_information":[{"code":"599","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Malignant Breast Disorders With Cc/Mcc","code_information":[{"code":"600","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Malignant Breast Disorders Without Cc/Mcc","code_information":[{"code":"601","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cellulitis With Mcc","code_information":[{"code":"602","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cellulitis Without Mcc","code_information":[{"code":"603","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"1 through 10","median_amount":147343.95,"10th_percentile":147343.95,"90th_percentile":147343.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"1 through 10","median_amount":13300.0,"10th_percentile":13300.0,"90th_percentile":13300.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc","code_information":[{"code":"604","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc","code_information":[{"code":"605","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Skin Disorders With Mcc","code_information":[{"code":"606","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Skin Disorders Without Mcc","code_information":[{"code":"607","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Adrenal And Pituitary Procedures With Cc/Mcc","code_information":[{"code":"614","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Adrenal And Pituitary Procedures Without Cc/Mcc","code_information":[{"code":"615","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc","code_information":[{"code":"616","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc","code_information":[{"code":"617","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","code_information":[{"code":"618","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures For Obesity With Mcc","code_information":[{"code":"619","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures For Obesity With Cc","code_information":[{"code":"620","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures For Obesity Without Cc/Mcc","code_information":[{"code":"621","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc","code_information":[{"code":"622","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc","code_information":[{"code":"623","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","code_information":[{"code":"624","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc","code_information":[{"code":"625","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures With Cc","code_information":[{"code":"626","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc","code_information":[{"code":"627","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc","code_information":[{"code":"628","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc","code_information":[{"code":"629","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc","code_information":[{"code":"630","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes With Mcc","code_information":[{"code":"637","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"1 through 10","median_amount":24700.0,"10th_percentile":24700.0,"90th_percentile":24700.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes With Cc","code_information":[{"code":"638","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"1 through 10","median_amount":30400.0,"10th_percentile":30400.0,"90th_percentile":30400.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes Without Cc/Mcc","code_information":[{"code":"639","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","code_information":[{"code":"640","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","code_information":[{"code":"641","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inborn And Other Disorders Of Metabolism","code_information":[{"code":"642","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders With Mcc","code_information":[{"code":"643","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders With Cc","code_information":[{"code":"644","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders Without Cc/Mcc","code_information":[{"code":"645","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"OSFDAN","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2297] [ICU-Per Diem: 2297] [CCU-Per Diem: 2297] [Step Down-Per Diem: 2297] [Rehab-Per Diem: 2065] [SNF-Per Diem: 2065]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant With Hemodialysis With Mcc","code_information":[{"code":"650","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2319] [ICU-Per Diem: 2497] [Rehab-Per Diem: 1895]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2293.24] [ICU-Per Diem: 2293.24] [Rehab-Per Diem: 2293.24] [SNF-Per Diem: 2293.24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2076.38] [ICU-Per Diem: 2076.38] [Rehab-Per Diem: 2076.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2494.31] [ICU-Per Diem: 2494.31] [Rehab-Per Diem: 2494.31] [SNF-Per Diem: 2494.31]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2488] [ICU-Per Diem: 2782] [Rehab-Per Diem: 2072]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3167 Charge Threshold 109302 (%BC): 47] [ICU-Per Diem: 3167] [IP High Cost Drugs ($): 0 Charge Threshold 344 (%BC): 39]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1900] [ICU-Per Diem: 1900] [Rehab-Per Diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatie