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Type: DMCC"}]},{"description":"HC M0220 TIXAGEV AND CILGAV ASTRA ZENECA INJ ADMIN & POST MONITORING","code_information":[{"code":"9400280","type":"CDM"},{"code":"0771","type":"RC"},{"code":"M0220","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":92.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: DMCC"}]},{"description":"HC SELF-MANAGEMENT TRAINING-INDIVIDUAL, EACH 30 MIN","code_information":[{"code":"9420024","type":"CDM"},{"code":"0942","type":"RC"},{"code":"98960","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":90.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: DMCC"}]},{"description":"Nervous System Neoplasms With Mcc","code_information":[{"code":"054","type":"MS-DRG"}],"standard_charges":[{"minimum":1881.0,"maximum":59372.7,"setting":"inpatient","payers_information":[{"payer_name":"Medicaid Illinois","plan_name":"Medicaid Illinois","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13808.76,"methodology":"other"},{"payer_name":"Medicaid Meridian Health Plan","plan_name":"Meridian Medicaid Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1881.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Part A And B","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":58983.88,"methodology":"other"},{"payer_name":"Medicare C Aetna","plan_name":"Medicare C Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":59372.7,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Nervous System Neoplasms Without Mcc","code_information":[{"code":"055","type":"MS-DRG"}],"standard_charges":[{"minimum":22800.0,"maximum":64211.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Soi","plan_name":"Aetna Soi","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":48845.0,"methodology":"other"},{"payer_name":"Medicaid Molina","plan_name":"Molina Healthcare Of Il Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22800.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Part A And B","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":58983.88,"methodology":"other"},{"payer_name":"Medicare C Aetna","plan_name":"Medicare C Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":64211.12,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Degenerative Nervous System Disorders With Mcc","code_information":[{"code":"056","type":"MS-DRG"}],"standard_charges":[{"minimum":14937.96,"maximum":241442.38,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":50658.09,"methodology":"other"},{"payer_name":"Blue Cross Il Osf Employee","plan_name":"Bcbs Ppo Osf Il Locations","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":241442.38,"methodology":"other"},{"payer_name":"Caterpillar Uhc","plan_name":"Caterpillar Uhc","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14937.96,"methodology":"other"},{"payer_name":"Health Alliance","plan_name":"Health Alliance Hmo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45000.0,"methodology":"other"},{"payer_name":"Medicaid Illinois","plan_name":"Medicaid Illinois","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17870.16,"methodology":"other"},{"payer_name":"Medicaid Meridian Health Plan","plan_name":"Meridian Medicaid Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":87400.0,"methodology":"other"},{"payer_name":"Medicaid Molina","plan_name":"Molina Healthcare Of Il Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30400.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Part A","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":91494.54,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Part A And B","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":70656.86,"methodology":"other"},{"payer_name":"Medicare C Aetna","plan_name":"Medicare C Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":77914.48,"methodology":"other"},{"payer_name":"Medicare C Humana","plan_name":"Medicare C Humana Hmo/Gold Plus","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":61737.4,"methodology":"other"},{"payer_name":"Medicare C Humana","plan_name":"Medicare C Humana Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":68446.02,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Uhc","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":70210.0,"methodology":"other"},{"payer_name":"Va Community Care Network","plan_name":"Va Community Care Network","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":75416.8,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Degenerative Nervous System Disorders Without Mcc","code_information":[{"code":"057","type":"MS-DRG"}],"standard_charges":[{"minimum":12996.48,"maximum":99939.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Inc","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":71425.0,"methodology":"other"},{"payer_name":"Aetna Soi","plan_name":"Aetna Soi","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24210.0,"methodology":"other"},{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Bce","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":84277.54,"methodology":"other"},{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Bco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30398.37,"methodology":"other"},{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28947.48,"methodology":"other"},{"payer_name":"Blue Cross Il Osf Employee","plan_name":"Bcbs Ppo Osf Il Locations","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":54700.54,"methodology":"other"},{"payer_name":"Caterpillar Bcbs","plan_name":"Caterpillar Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32656.0,"methodology":"other"},{"payer_name":"Caterpillar Uhc","plan_name":"Caterpillar Uhc","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23968.24,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36994.16,"methodology":"other"},{"payer_name":"Health Alliance","plan_name":"Health Alliance Marketplace","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30000.0,"methodology":"other"},{"payer_name":"Health Alliance","plan_name":"Health Alliance Hmo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":35000.0,"methodology":"other"},{"payer_name":"Medicaid Aetna Better Health","plan_name":"Aetna Better Health Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26600.0,"methodology":"other"},{"payer_name":"Medicaid Illinois","plan_name":"Medicaid Illinois","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12996.48,"methodology":"other"},{"payer_name":"Medicaid Meridian Health Plan","plan_name":"Meridian Medicaid Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":47500.0,"methodology":"other"},{"payer_name":"Medicaid Molina","plan_name":"Molina Healthcare Of Il Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32300.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Part A And B","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45871.4,"methodology":"other"},{"payer_name":"Medicare C Aetna","plan_name":"Medicare C Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":41785.98,"methodology":"other"},{"payer_name":"Medicare C Health Alliance","plan_name":"Medicare C Health Alliance Hmo Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":75011.62,"methodology":"other"},{"payer_name":"Medicare C Humana","plan_name":"Medicare C Humana Hmo/Gold Plus","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":51949.18,"methodology":"other"},{"payer_name":"Medicare C Humana","plan_name":"Medicare C Humana Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":56781.12,"methodology":"other"},{"payer_name":"Medicare C Molina","plan_name":"Medicare C Molina Healthcare Mmai","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":99939.4,"methodology":"other"},{"payer_name":"Medicare C Unitedhealthcare","plan_name":"Medicare C Unitedhealthcare Advantage","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":46835.34,"methodology":"other"},{"payer_name":"Medicare C Wellcare","plan_name":"Medicare C Wellcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33249.72,"methodology":"other"},{"payer_name":"Umr Uhc","plan_name":"Uhc Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37170.0,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Uhc","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":49560.0,"methodology":"other"},{"payer_name":"Va Community Care Network","plan_name":"Va Community Care Network","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":50533.24,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia With Cc","code_information":[{"code":"059","type":"MS-DRG"}],"standard_charges":[{"minimum":22572.0,"maximum":79800.0,"setting":"inpatient","payers_information":[{"payer_name":"Medicaid Aetna Better Health","plan_name":"Aetna Better Health Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":79800.0,"methodology":"other"},{"payer_name":"Medicaid Meridian Health Plan","plan_name":"Meridian Medicaid Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22572.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Part A And B","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":50765.78,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","code_information":[{"code":"060","type":"MS-DRG"}],"standard_charges":[{"minimum":31770.36,"maximum":31770.36,"setting":"inpatient","payers_information":[{"payer_name":"Medicare C Humana","plan_name":"Medicare C Humana Pffs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31770.36,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","code_information":[{"code":"064","type":"MS-DRG"}],"standard_charges":[{"minimum":45391.24,"maximum":45391.24,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Part A And B","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45391.24,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","code_information":[{"code":"065","type":"MS-DRG"}],"standard_charges":[{"minimum":74564.62,"maximum":74955.3,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Part A And B","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":74955.3,"methodology":"other"},{"payer_name":"Medicare C Humana","plan_name":"Medicare C Humana Hmo/Gold Plus","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":74564.62,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Cerebrovascular Disorders With Mcc","code_information":[{"code":"070","type":"MS-DRG"}],"standard_charges":[{"minimum":28500.0,"maximum":28500.0,"setting":"inpatient","payers_information":[{"payer_name":"Medicaid Aetna Better Health","plan_name":"Aetna Better Health Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28500.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Cerebrovascular Disorders With Cc","code_information":[{"code":"071","type":"MS-DRG"}],"standard_charges":[{"minimum":28500.0,"maximum":28500.0,"setting":"inpatient","payers_information":[{"payer_name":"Medicaid Molina","plan_name":"Molina Healthcare Of Il Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28500.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Cerebrovascular Disorders Without Cc/Mcc","code_information":[{"code":"072","type":"MS-DRG"}],"standard_charges":[{"minimum":28351.96,"maximum":28351.96,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Part A And B","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28351.96,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cranial And Peripheral Nerve Disorders Without Mcc","code_information":[{"code":"074","type":"MS-DRG"}],"standard_charges":[{"minimum":40221.34,"maximum":190000.0,"setting":"inpatient","payers_information":[{"payer_name":"Health Alliance","plan_name":"Health Alliance Hmo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":190000.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Part A And B","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":40221.34,"methodology":"other"},{"payer_name":"Medicare C Aetna","plan_name":"Medicare C Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":58592.72,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Disorders Of Nervous System With Mcc","code_information":[{"code":"091","type":"MS-DRG"}],"standard_charges":[{"minimum":13808.76,"maximum":124931.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Soi","plan_name":"Aetna Soi","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":49270.0,"methodology":"other"},{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Bce","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":55037.76,"methodology":"other"},{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":55482.67,"methodology":"other"},{"payer_name":"Medicaid Aetna Better Health","plan_name":"Aetna Better Health Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":77900.0,"methodology":"other"},{"payer_name":"Medicaid Illinois","plan_name":"Medicaid Illinois","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13808.76,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Part A And B","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":124931.22,"methodology":"other"},{"payer_name":"Medicare C Aetna","plan_name":"Medicare C Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":46715.22,"methodology":"other"},{"payer_name":"Medicare C Humana","plan_name":"Medicare C Humana Hmo/Gold Plus","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":57814.16,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Disorders Of Nervous System With Cc","code_information":[{"code":"092","type":"MS-DRG"}],"standard_charges":[{"minimum":10559.64,"maximum":68400.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Soi","plan_name":"Aetna Soi","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30320.0,"methodology":"other"},{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22013.7,"methodology":"other"},{"payer_name":"Medicaid Aetna Better Health","plan_name":"Aetna Better Health Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":68400.0,"methodology":"other"},{"payer_name":"Medicaid Illinois","plan_name":"Medicaid Illinois","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10559.64,"methodology":"other"},{"payer_name":"Medicaid Molina","plan_name":"Molina Healthcare Of Il Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":58900.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Part A And B","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":46495.26,"methodology":"other"},{"payer_name":"Medicare C Aetna","plan_name":"Medicare C Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":54190.78,"methodology":"other"},{"payer_name":"Medicare C Wellcare","plan_name":"Medicare C Wellcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":43584.86,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Disorders Of Nervous System Without Cc/Mcc","code_information":[{"code":"093","type":"MS-DRG"}],"standard_charges":[{"minimum":35115.26,"maximum":86416.02,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":41613.19,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Part A And B","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":81304.42,"methodology":"other"},{"payer_name":"Medicare C Aetna","plan_name":"Medicare C Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":78516.78,"methodology":"other"},{"payer_name":"Medicare C Molina","plan_name":"Medicare C Molina Healthcare Mmai","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":86416.02,"methodology":"other"},{"payer_name":"Va Community Care Network","plan_name":"Va Community Care Network","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":35115.26,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Mcc","code_information":[{"code":"094","type":"MS-DRG"}],"standard_charges":[{"minimum":8837.99,"maximum":86086.46,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Part A And B","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8837.99,"methodology":"other"},{"payer_name":"Medicare C Aetna","plan_name":"Medicare C Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":86086.46,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Cc","code_information":[{"code":"095","type":"MS-DRG"}],"standard_charges":[{"minimum":94665.7,"maximum":94665.7,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Part A And B","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":94665.7,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","code_information":[{"code":"098","type":"MS-DRG"}],"standard_charges":[{"minimum":36565.28,"maximum":36565.28,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Il Soi","plan_name":"Blue Choice Soi Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36565.28,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","code_information":[{"code":"099","type":"MS-DRG"}],"standard_charges":[{"minimum":31413.86,"maximum":31413.86,"setting":"inpatient","payers_information":[{"payer_name":"Medicare C Aetna","plan_name":"Medicare C Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31413.86,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Seizures With Mcc","code_information":[{"code":"100","type":"MS-DRG"}],"standard_charges":[{"minimum":41707.68,"maximum":57331.0,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Il Soi","plan_name":"Blue Choice Soi Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":57331.0,"methodology":"other"},{"payer_name":"Medicare C Wellcare","plan_name":"Medicare C Wellcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":41707.68,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Seizures Without Mcc","code_information":[{"code":"101","type":"MS-DRG"}],"standard_charges":[{"minimum":8935.08,"maximum":62757.06,"setting":"inpatient","payers_information":[{"payer_name":"Medicaid Illinois","plan_name":"Medicaid Illinois","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8935.08,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Part A And B","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":59066.84,"methodology":"other"},{"payer_name":"Medicare C Aetna","plan_name":"Medicare C Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":62757.06,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Neurological Eye Disorders","code_information":[{"code":"123","type":"MS-DRG"}],"standard_charges":[{"minimum":5807.78,"maximum":50658.09,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":50658.09,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Part A And B","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5807.78,"methodology":"other"},{"payer_name":"Medicare C Bcbs Il Out Of State","plan_name":"Medicare C Bcbs Il Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":44238.26,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc","code_information":[{"code":"148","type":"MS-DRG"}],"standard_charges":[{"minimum":59323.84,"maximum":59323.84,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Part A And B","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":59323.84,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","code_information":[{"code":"175","type":"MS-DRG"}],"standard_charges":[{"minimum":26600.0,"maximum":26600.0,"setting":"inpatient","payers_information":[{"payer_name":"Medicaid Molina","plan_name":"Molina Healthcare Of Il Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26600.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Respiratory Infections And Inflammations With Mcc","code_information":[{"code":"177","type":"MS-DRG"}],"standard_charges":[{"minimum":43643.0,"maximum":85166.56,"setting":"inpatient","payers_information":[{"payer_name":"Medicare C Bcbs Il Out Of State","plan_name":"Medicare C Bcbs Il Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":85166.56,"methodology":"other"},{"payer_name":"Umr Uhc","plan_name":"Uhc Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":43643.0,"methodology":"other"},{"payer_name":"Va Community Care Network","plan_name":"Va Community Care Network","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":62657.38,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Respiratory Neoplasms With Mcc","code_information":[{"code":"180","type":"MS-DRG"}],"standard_charges":[{"minimum":17100.0,"maximum":30000.0,"setting":"inpatient","payers_information":[{"payer_name":"Health Alliance","plan_name":"Health Alliance Marketplace","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30000.0,"methodology":"other"},{"payer_name":"Medicaid Molina","plan_name":"Molina Healthcare Of Il Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17100.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pulmonary Edema And Respiratory Failure","code_information":[{"code":"189","type":"MS-DRG"}],"standard_charges":[{"minimum":8529.22,"maximum":63738.58,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":41008.93,"methodology":"other"},{"payer_name":"Medicaid Aetna Better Health","plan_name":"Aetna Better Health Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30400.0,"methodology":"other"},{"payer_name":"Medicaid Meridian Health Plan","plan_name":"Meridian Medicaid Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":34200.0,"methodology":"other"},{"payer_name":"Medicaid Molina","plan_name":"Molina Healthcare Of Il Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":38000.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Part A And B","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":41189.64,"methodology":"other"},{"payer_name":"Medicare C Bcbs Il Mmai","plan_name":"Medicare C Bcbs Il Mmai","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":39141.85,"methodology":"other"},{"payer_name":"Medicare C Bcbs Ppo","plan_name":"Medicare C Bcbs Il Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":41147.74,"methodology":"other"},{"payer_name":"Medicare C Humana","plan_name":"Medicare C Humana Hmo/Gold Plus","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":41147.73,"methodology":"other"},{"payer_name":"Medicare C Meridian","plan_name":"Medicare C Meridan Complete Mmai","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":63738.58,"methodology":"other"},{"payer_name":"Medicare C Molina","plan_name":"Medicare C Molina Healthcare Mmai","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8529.22,"methodology":"other"},{"payer_name":"Medicare C Unitedhealthcare","plan_name":"Medicare C Unitedhealthcare Advantage","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":39324.95,"methodology":"other"},{"payer_name":"Medicare C Wellcare","plan_name":"Medicare C Wellcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45216.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Chronic Obstructive Pulmonary Disease With Cc","code_information":[{"code":"191","type":"MS-DRG"}],"standard_charges":[{"minimum":77690.7,"maximum":77690.7,"setting":"inpatient","payers_information":[{"payer_name":"Medicare Railroad","plan_name":"Medicare Railroad A And B","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":77690.7,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Respiratory System Diagnosis With Ventilator Support >96 Hours","code_information":[{"code":"207","type":"MS-DRG"}],"standard_charges":[{"minimum":13782.0,"maximum":81757.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Inc","plan_name":"Aetna Exchange Hmo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":53693.0,"methodology":"other"},{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":57894.96,"methodology":"other"},{"payer_name":"Caterpillar Uhc","plan_name":"Caterpillar Uhc","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27820.0,"methodology":"other"},{"payer_name":"Medicaid Aetna Better Health","plan_name":"Aetna Better Health Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24700.0,"methodology":"other"},{"payer_name":"Medicaid Meridian Health Plan","plan_name":"Meridian Medicaid Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":55100.0,"methodology":"other"},{"payer_name":"Medicaid Molina","plan_name":"Molina Healthcare Of Il Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":62700.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Part A","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":80254.08,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Part A And B","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":81757.33,"methodology":"other"},{"payer_name":"Medicare C Aetna","plan_name":"Medicare C Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":49803.43,"methodology":"other"},{"payer_name":"Medicare C Bcbs Ppo","plan_name":"Medicare C Bcbs Il Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":81757.33,"methodology":"other"},{"payer_name":"Medicare C Health Alliance","plan_name":"Medicare C Health Alliance Hmo Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36144.17,"methodology":"other"},{"payer_name":"Medicare C Humana","plan_name":"Medicare C Humana Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":81757.33,"methodology":"other"},{"payer_name":"Medicare C Molina","plan_name":"Medicare C Molina Healthcare Mmai","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":48351.27,"methodology":"other"},{"payer_name":"Medicare C Unitedhealthcare","plan_name":"Medicare C Unitedhealthcare Advantage","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":81757.34,"methodology":"other"},{"payer_name":"Medicare C Wellcare","plan_name":"Medicare C Wellcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37680.0,"methodology":"other"},{"payer_name":"Umr Uhc","plan_name":"Uhc Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32158.0,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Uhc","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13782.0,"methodology":"other"},{"payer_name":"Va Community Care Network","plan_name":"Va Community Care Network","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":50819.82,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Respiratory System Diagnosis With Ventilator Support <=96 Hours","code_information":[{"code":"208","type":"MS-DRG"}],"standard_charges":[{"minimum":7600.0,"maximum":66534.9,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Bce","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":66534.9,"methodology":"other"},{"payer_name":"Health Alliance","plan_name":"Health Alliance Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":39312.64,"methodology":"other"},{"payer_name":"Medicaid Meridian Health Plan","plan_name":"Meridian Medicaid Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7600.0,"methodology":"other"},{"payer_name":"Medicaid Molina","plan_name":"Molina Healthcare Of Il Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":51300.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Circulatory System O.R. Procedures","code_information":[{"code":"264","type":"MS-DRG"}],"standard_charges":[{"minimum":24453.0,"maximum":24453.0,"setting":"inpatient","payers_information":[{"payer_name":"Medicaid Meridian Health Plan","plan_name":"Meridian Medicaid Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24453.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Mcc","code_information":[{"code":"280","type":"MS-DRG"}],"standard_charges":[{"minimum":34912.14,"maximum":34912.14,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Part A And B","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":34912.14,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","code_information":[{"code":"282","type":"MS-DRG"}],"standard_charges":[{"minimum":35213.56,"maximum":35213.56,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Part A And B","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":35213.56,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Acute And Subacute Endocarditis With Mcc","code_information":[{"code":"288","type":"MS-DRG"}],"standard_charges":[{"minimum":11136.75,"maximum":62700.0,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Bce","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27518.88,"methodology":"other"},{"payer_name":"Medicaid Molina","plan_name":"Molina Healthcare Of Il Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":62700.0,"methodology":"other"},{"payer_name":"Medicare C Bcbs Ppo","plan_name":"Medicare C Bcbs Il Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11136.75,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Acute And Subacute Endocarditis With Cc","code_information":[{"code":"289","type":"MS-DRG"}],"standard_charges":[{"minimum":38000.0,"maximum":53200.0,"setting":"inpatient","payers_information":[{"payer_name":"Medicaid Aetna Better Health","plan_name":"Aetna Better Health Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":38000.0,"methodology":"other"},{"payer_name":"Medicaid Molina","plan_name":"Molina Healthcare Of Il Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":53200.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Heart Failure And Shock With Mcc","code_information":[{"code":"291","type":"MS-DRG"}],"standard_charges":[{"minimum":43174.3,"maximum":63138.73,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Part A And B","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":43174.3,"methodology":"other"},{"payer_name":"Medicare C Meridian","plan_name":"Medicare C Meridan Complete Mmai","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":63138.73,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Heart Failure And Shock With Cc","code_information":[{"code":"292","type":"MS-DRG"}],"standard_charges":[{"minimum":36005.0,"maximum":83970.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Inc","plan_name":"Aetna Exchange Hmo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36005.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Part A And B","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":38295.58,"methodology":"other"},{"payer_name":"Medicare C Health Alliance","plan_name":"Medicare C Health Alliance Hmo Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":77475.62,"methodology":"other"},{"payer_name":"Medicare C Humana","plan_name":"Medicare C Humana Hmo/Gold Plus","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":83970.54,"methodology":"other"},{"payer_name":"Medicare C Humana","plan_name":"Medicare C Humana Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":50299.28,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Peripheral Vascular Disorders With Mcc","code_information":[{"code":"299","type":"MS-DRG"}],"standard_charges":[{"minimum":34200.0,"maximum":91489.08,"setting":"inpatient","payers_information":[{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":91489.08,"methodology":"other"},{"payer_name":"Medicaid Aetna Better Health","plan_name":"Aetna Better Health Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":38000.0,"methodology":"other"},{"payer_name":"Medicaid Meridian Health Plan","plan_name":"Meridian Medicaid Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":34200.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Part A And B","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":50589.18,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Peripheral Vascular Disorders With Cc","code_information":[{"code":"300","type":"MS-DRG"}],"standard_charges":[{"minimum":13300.0,"maximum":94055.58,"setting":"inpatient","payers_information":[{"payer_name":"Medicaid Molina","plan_name":"Molina Healthcare Of Il Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13300.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Part A And B","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":94055.58,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Congenital And Valvular Disorders Without Mcc","code_information":[{"code":"307","type":"MS-DRG"}],"standard_charges":[{"minimum":43174.3,"maximum":43174.3,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Part A And B","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":43174.3,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Mcc","code_information":[{"code":"308","type":"MS-DRG"}],"standard_charges":[{"minimum":47500.0,"maximum":47500.0,"setting":"inpatient","payers_information":[{"payer_name":"Medicaid Meridian Health Plan","plan_name":"Meridian Medicaid Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":47500.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Cc","code_information":[{"code":"309","type":"MS-DRG"}],"standard_charges":[{"minimum":40087.4,"maximum":40087.4,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Part A And B","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":40087.4,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Circulatory System Diagnoses With Mcc","code_information":[{"code":"314","type":"MS-DRG"}],"standard_charges":[{"minimum":27205.78,"maximum":36100.0,"setting":"inpatient","payers_information":[{"payer_name":"Medicaid Illinois","plan_name":"Medicaid Illinois","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27205.78,"methodology":"other"},{"payer_name":"Medicaid Meridian Health Plan","plan_name":"Meridian Medicaid Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36100.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","code_information":[{"code":"373","type":"MS-DRG"}],"standard_charges":[{"minimum":46781.08,"maximum":46781.08,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Part A And B","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":46781.08,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Complicated Peptic Ulcer With Cc","code_information":[{"code":"381","type":"MS-DRG"}],"standard_charges":[{"minimum":111771.1,"maximum":111771.1,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Part A And B","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":111771.1,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inflammatory Bowel Disease With Mcc","code_information":[{"code":"385","type":"MS-DRG"}],"standard_charges":[{"minimum":50140.61,"maximum":50140.61,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Part A And B","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":50140.61,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","code_information":[{"code":"391","type":"MS-DRG"}],"standard_charges":[{"minimum":49400.0,"maximum":49400.0,"setting":"inpatient","payers_information":[{"payer_name":"Medicaid Meridian Health Plan","plan_name":"Meridian Medicaid Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":49400.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Digestive System Diagnoses With Mcc","code_information":[{"code":"393","type":"MS-DRG"}],"standard_charges":[{"minimum":13300.0,"maximum":13300.0,"setting":"inpatient","payers_information":[{"payer_name":"Medicaid Meridian Health Plan","plan_name":"Meridian Medicaid Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13300.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Digestive System Diagnoses With Cc","code_information":[{"code":"394","type":"MS-DRG"}],"standard_charges":[{"minimum":25605.44,"maximum":43047.0,"setting":"inpatient","payers_information":[{"payer_name":"Medicaid Illinois","plan_name":"Medicaid Illinois","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":43047.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Part A And B","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25605.44,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Disorders Of Pancreas Except Malignancy With Mcc","code_information":[{"code":"438","type":"MS-DRG"}],"standard_charges":[{"minimum":33772.06,"maximum":33772.06,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33772.06,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","code_information":[{"code":"440","type":"MS-DRG"}],"standard_charges":[{"minimum":33772.85,"maximum":33772.85,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Bco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33772.85,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","code_information":[{"code":"441","type":"MS-DRG"}],"standard_charges":[{"minimum":40379.67,"maximum":40379.67,"setting":"inpatient","payers_information":[{"payer_name":"Bcbs Hmoi Osfhealthcare Central","plan_name":"Bcbs Hmo Osf 476 C Blue Precision","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":40379.67,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Disorders Of The Biliary Tract With Cc","code_information":[{"code":"445","type":"MS-DRG"}],"standard_charges":[{"minimum":43700.0,"maximum":43700.0,"setting":"inpatient","payers_information":[{"payer_name":"Medicaid Molina","plan_name":"Molina Healthcare Of Il Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":43700.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"463","type":"MS-DRG"}],"standard_charges":[{"minimum":25811.0,"maximum":25811.0,"setting":"inpatient","payers_information":[{"payer_name":"Medicare C Wellcare","plan_name":"Medicare C Wellcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25811.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Soft Tissue Procedures With Cc","code_information":[{"code":"501","type":"MS-DRG"}],"standard_charges":[{"minimum":88516.32,"maximum":88516.32,"setting":"inpatient","payers_information":[{"payer_name":"Medicare C Health Alliance","plan_name":"Medicare C Health Alliance Hmo Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":88516.32,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Osteomyelitis With Cc","code_information":[{"code":"540","type":"MS-DRG"}],"standard_charges":[{"minimum":48980.6,"maximum":48980.6,"setting":"inpatient","payers_information":[{"payer_name":"Medicare C Humana","plan_name":"Medicare C Humana Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":48980.6,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Septic Arthritis With Cc","code_information":[{"code":"549","type":"MS-DRG"}],"standard_charges":[{"minimum":49400.0,"maximum":49400.0,"setting":"inpatient","payers_information":[{"payer_name":"Medicaid Molina","plan_name":"Molina Healthcare Of Il Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":49400.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Medical Back Problems With Mcc","code_information":[{"code":"551","type":"MS-DRG"}],"standard_charges":[{"minimum":56419.82,"maximum":56419.82,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Part A And B","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":56419.82,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Medical Back Problems Without Mcc","code_information":[{"code":"552","type":"MS-DRG"}],"standard_charges":[{"minimum":8122.8,"maximum":107128.96,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Il Osf Employee","plan_name":"Bcbs Ppo Osf Il Locations","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":62719.54,"methodology":"other"},{"payer_name":"Medicaid Illinois","plan_name":"Medicaid Illinois","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8122.8,"methodology":"other"},{"payer_name":"Medicaid Molina","plan_name":"Molina Healthcare Of Il Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32300.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Part A And B","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":44200.24,"methodology":"other"},{"payer_name":"Medicare C Aetna","plan_name":"Medicare C Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":107128.96,"methodology":"other"},{"payer_name":"Medicare C Unitedhealthcare","plan_name":"Medicare C Unitedhealthcare Advantage","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":101673.62,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Tendonitis, Myositis And Bursitis With Mcc","code_information":[{"code":"557","type":"MS-DRG"}],"standard_charges":[{"minimum":77558.0,"maximum":77558.0,"setting":"inpatient","payers_information":[{"payer_name":"Caterpillar Bcbs","plan_name":"Caterpillar Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":77558.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Tendonitis, Myositis And Bursitis Without Mcc","code_information":[{"code":"558","type":"MS-DRG"}],"standard_charges":[{"minimum":15200.0,"maximum":42713.16,"setting":"inpatient","payers_information":[{"payer_name":"Health Alliance","plan_name":"Health Alliance Marketplace","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20000.0,"methodology":"other"},{"payer_name":"Medicaid Aetna Better Health","plan_name":"Aetna Better Health Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15200.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Part A And B","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":42713.16,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"559","type":"MS-DRG"}],"standard_charges":[{"minimum":16245.6,"maximum":142325.11,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":142325.11,"methodology":"other"},{"payer_name":"Health Alliance","plan_name":"Health Alliance Marketplace","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36142.7,"methodology":"other"},{"payer_name":"Medicaid Illinois","plan_name":"Medicaid Illinois","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16245.6,"methodology":"other"},{"payer_name":"Medicaid Molina","plan_name":"Molina Healthcare Of Il Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24700.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Part A","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":116628.62,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Part A And B","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":77270.54,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Cc","code_information":[{"code":"560","type":"MS-DRG"}],"standard_charges":[{"minimum":12996.48,"maximum":75775.4,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Bcs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":55363.0,"methodology":"other"},{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45833.51,"methodology":"other"},{"payer_name":"Medicaid Aetna Better Health","plan_name":"Aetna Better Health Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36100.0,"methodology":"other"},{"payer_name":"Medicaid Illinois","plan_name":"Medicaid Illinois","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12996.48,"methodology":"other"},{"payer_name":"Medicaid Meridian Health Plan","plan_name":"Meridian Medicaid Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":49419.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Part A","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37332.28,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Part A And B","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":49834.26,"methodology":"other"},{"payer_name":"Medicare C Aetna","plan_name":"Medicare C Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":75775.4,"methodology":"other"},{"payer_name":"Medicare C Humana","plan_name":"Medicare C Humana Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45173.64,"methodology":"other"},{"payer_name":"Medicare C Meridian","plan_name":"Medicare C Meridan Complete Mmai","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":39982.3,"methodology":"other"},{"payer_name":"Medicare C Molina","plan_name":"Medicare C Molina Healthcare Mmai","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":47917.82,"methodology":"other"},{"payer_name":"Medicare C Wellcare","plan_name":"Medicare C Wellcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":49448.96,"methodology":"other"},{"payer_name":"Va Community Care Network","plan_name":"Va Community Care Network","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28157.7,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","code_information":[{"code":"561","type":"MS-DRG"}],"standard_charges":[{"minimum":7718.21,"maximum":55482.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Consociate","plan_name":"Aetna Asa Consociate","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24635.0,"methodology":"other"},{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":55482.67,"methodology":"other"},{"payer_name":"Health Alliance","plan_name":"Health Alliance Hmo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":40000.0,"methodology":"other"},{"payer_name":"Medicaid Illinois","plan_name":"Medicaid Illinois","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14621.04,"methodology":"other"},{"payer_name":"Medicaid Meridian Health Plan","plan_name":"Meridian Medicaid Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26600.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Part A And B","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":43413.26,"methodology":"other"},{"payer_name":"Medicare C Unitedhealthcare","plan_name":"Medicare C Unitedhealthcare Advantage","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":39047.56,"methodology":"other"},{"payer_name":"Umr Uhc","plan_name":"Uhc Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32570.65,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Uhc","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7718.21,"methodology":"other"},{"payer_name":"Va Community Care Network","plan_name":"Va Community Care Network","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":46512.58,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Skin Debridement With Mcc","code_information":[{"code":"570","type":"MS-DRG"}],"standard_charges":[{"minimum":144552.43,"maximum":144552.43,"setting":"inpatient","payers_information":[{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":144552.43,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Skin Ulcers With Mcc","code_information":[{"code":"592","type":"MS-DRG"}],"standard_charges":[{"minimum":37226.56,"maximum":37226.56,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Part A And B","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37226.56,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Skin Ulcers With Cc","code_information":[{"code":"593","type":"MS-DRG"}],"standard_charges":[{"minimum":64600.0,"maximum":64600.0,"setting":"inpatient","payers_information":[{"payer_name":"Medicaid Aetna Better Health","plan_name":"Aetna Better Health Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":64600.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cellulitis With Mcc","code_information":[{"code":"602","type":"MS-DRG"}],"standard_charges":[{"minimum":26600.0,"maximum":26600.0,"setting":"inpatient","payers_information":[{"payer_name":"Medicaid Meridian Health Plan","plan_name":"Meridian Medicaid Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26600.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cellulitis Without Mcc","code_information":[{"code":"603","type":"MS-DRG"}],"standard_charges":[{"minimum":13300.0,"maximum":36964.22,"setting":"inpatient","payers_information":[{"payer_name":"Medicaid Molina","plan_name":"Molina Healthcare Of Il Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13300.0,"methodology":"other"},{"payer_name":"Medicare C Aetna","plan_name":"Medicare C Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36964.22,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Diabetes With Mcc","code_information":[{"code":"637","type":"MS-DRG"}],"standard_charges":[{"minimum":15259.43,"maximum":41800.0,"setting":"inpatient","payers_information":[{"payer_name":"Medicaid Molina","plan_name":"Molina Healthcare Of Il Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":41800.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Part A And B","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15259.43,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Diabetes With Cc","code_information":[{"code":"638","type":"MS-DRG"}],"standard_charges":[{"minimum":28805.97,"maximum":32300.0,"setting":"inpatient","payers_information":[{"payer_name":"Medicaid Molina","plan_name":"Molina Healthcare Of Il Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32300.0,"methodology":"other"},{"payer_name":"Va Community Care Network","plan_name":"Va Community Care Network","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28805.97,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Renal Failure With Mcc","code_information":[{"code":"682","type":"MS-DRG"}],"standard_charges":[{"minimum":37439.96,"maximum":37439.96,"setting":"inpatient","payers_information":[{"payer_name":"Va Community Care Network","plan_name":"Va Community Care Network","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37439.96,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inflammation Of The Male Reproductive System With Mcc","code_information":[{"code":"727","type":"MS-DRG"}],"standard_charges":[{"minimum":32300.0,"maximum":32300.0,"setting":"inpatient","payers_information":[{"payer_name":"Medicaid Molina","plan_name":"Molina Healthcare Of Il Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32300.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Postpartum And Post Abortion Diagnoses Without O.R. Procedures","code_information":[{"code":"776","type":"MS-DRG"}],"standard_charges":[{"minimum":55717.91,"maximum":55717.91,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":55717.91,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Red Blood Cell Disorders Without Mcc","code_information":[{"code":"812","type":"MS-DRG"}],"standard_charges":[{"minimum":25600.98,"maximum":25600.98,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Part A And B","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25600.98,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc","code_information":[{"code":"843","type":"MS-DRG"}],"standard_charges":[{"minimum":36198.14,"maximum":36198.14,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Part A And B","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36198.14,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Postoperative And Post-Traumatic Infections Without Mcc","code_information":[{"code":"863","type":"MS-DRG"}],"standard_charges":[{"minimum":57000.0,"maximum":57000.0,"setting":"inpatient","payers_information":[{"payer_name":"Medicaid Aetna Better Health","plan_name":"Aetna Better Health Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":57000.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","code_information":[{"code":"871","type":"MS-DRG"}],"standard_charges":[{"minimum":29646.78,"maximum":29646.78,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Part A And B","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29646.78,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Wound Debridements For Injuries With Mcc","code_information":[{"code":"901","type":"MS-DRG"}],"standard_charges":[{"minimum":11202.38,"maximum":11202.38,"setting":"inpatient","payers_information":[{"payer_name":"Medicaid Illinois","plan_name":"Medicaid Illinois","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11202.38,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Complications Of Treatment With Mcc","code_information":[{"code":"919","type":"MS-DRG"}],"standard_charges":[{"minimum":22800.0,"maximum":44858.07,"setting":"inpatient","payers_information":[{"payer_name":"Medicaid Meridian Health Plan","plan_name":"Meridian Medicaid Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22800.0,"methodology":"other"},{"payer_name":"Medicare C Health Alliance","plan_name":"Medicare C Health Alliance Hmo Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":41467.64,"methodology":"other"},{"payer_name":"Medicare C Unitedhealthcare","plan_name":"Medicare C Unitedhealthcare Advantage","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":44858.07,"methodology":"other"}],"billing_class":"facility"}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc","code_information":[{"code":"940","type":"MS-DRG"}],"standard_charges":[{"minimum":38271.26,"maximum":38271.26,"setting":"inpatient","payers_information":[{"payer_name":"Medicare C Wellcare","plan_name":"Medicare C Wellcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":38271.26,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Signs And Symptoms With Mcc","code_information":[{"code":"947","type":"MS-DRG"}],"standard_charges":[{"minimum":57412.32,"maximum":57412.32,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare Part A And B","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":57412.32,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Signs And Symptoms Without Mcc","code_information":[{"code":"948","type":"MS-DRG"}],"standard_charges":[{"minimum":34322.92,"maximum":48826.62,"setting":"inpatient","payers_information":[{"payer_name":"Medicare C Health Alliance","plan_name":"Medicare C Health Alliance Hmo Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":48826.62,"methodology":"other"},{"payer_name":"Va Community Care Network","plan_name":"Va Community Care Network","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":34322.92,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Aftercare With Cc/Mcc","code_information":[{"code":"949","type":"MS-DRG"}],"standard_charges":[{"minimum":10559.64,"maximum":89300.0,"setting":"inpatient","payers_information":[{"payer_name":"Bcbs Hmoi Osfhealthcare Central","plan_name":"Bcbs Hmo Osf 476 C Blue Precision","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33948.23,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":54915.3,"methodology":"other"},{"payer_name":"Medicaid Aetna Better Health","plan_name":"Aetna Better Health Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":89300.0,"methodology":"other"},{"payer_name":"Medicaid Illinois","plan_name":"Medicaid Illinois","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10559.64,"methodology":"other"},{"payer_name":"Medicaid Meridian Health Plan","plan_name":"Meridian Medicaid Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":87400.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Part A And B","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":49274.62,"methodology":"other"},{"payer_name":"Medicare C Aetna","plan_name":"Medicare C Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":55960.72,"methodology":"other"},{"payer_name":"Medicare C Aetna Better Health","plan_name":"Medicare C Aetna Better Health Mmai","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28225.6,"methodology":"other"},{"payer_name":"Medicare C Humana","plan_name":"Medicare C Humana Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":43174.3,"methodology":"other"},{"payer_name":"Medicare C Molina","plan_name":"Medicare C Molina Healthcare Mmai","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":43866.58,"methodology":"other"},{"payer_name":"Medicare C Wellcare","plan_name":"Medicare C Wellcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":40870.32,"methodology":"other"},{"payer_name":"Umr Uhc","plan_name":"Uhc Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":41300.0,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Uhc","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22715.0,"methodology":"other"},{"payer_name":"Va Community Care Network","plan_name":"Va Community Care Network","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37204.16,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Aftercare Without Cc/Mcc","code_information":[{"code":"950","type":"MS-DRG"}],"standard_charges":[{"minimum":11371.92,"maximum":38751.76,"setting":"inpatient","payers_information":[{"payer_name":"Medicaid Aetna Better Health","plan_name":"Aetna Better Health Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16245.68,"methodology":"other"},{"payer_name":"Medicaid Illinois","plan_name":"Medicaid Illinois","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11371.92,"methodology":"other"},{"payer_name":"Medicaid Molina","plan_name":"Molina Healthcare Of Il Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":34200.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare Part A And B","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":38751.76,"methodology":"other"},{"payer_name":"Medicare C Aetna","plan_name":"Medicare C Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31841.34,"methodology":"other"}],"billing_class":"facility"}]}],"modifier_information":[{"description":"Repeat Clinical Diagnostic Laboratory Test","code":"91","modifier_payer_information":[{"payer_name":"Aetna Consociate","plan_name":"Aetna Asa Consociate","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Inc","plan_name":"Aetna","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Inc","plan_name":"Aetna Exchange Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Soi","plan_name":"Aetna Soi","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs Hmoi Osfhealthcare Central","plan_name":"Bcbs Hmo Osf 476 C Blue Precision","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Bce","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Bco","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Bcs","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il Osf Employee","plan_name":"Bcbs Ppo Osf Il Locations","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il Soi","plan_name":"Blue Choice Soi Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caterpillar Bcbs","plan_name":"Caterpillar Bcbs","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caterpillar Uhc","plan_name":"Caterpillar Uhc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance","plan_name":"Health Alliance Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance","plan_name":"Health Alliance Marketplace","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance","plan_name":"Health Alliance Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Aetna Better Health","plan_name":"Aetna Better Health Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Illinois","plan_name":"Medicaid Illinois","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Meridian Health Plan","plan_name":"Meridian Medicaid Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Molina","plan_name":"Molina Healthcare Of Il Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"Medicare Part A","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"Medicare Part A And B","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Aetna","plan_name":"Medicare C Aetna","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Aetna Better Health","plan_name":"Medicare C Aetna Better Health Mmai","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Bcbs Il Mmai","plan_name":"Medicare C Bcbs Il Mmai","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Bcbs Il Out Of State","plan_name":"Medicare C Bcbs Il Out Of State","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Bcbs Ppo","plan_name":"Medicare C Bcbs Il Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Health Alliance","plan_name":"Medicare C Health Alliance Hmo Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Humana","plan_name":"Medicare C Humana Hmo/Gold Plus","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Humana","plan_name":"Medicare C Humana Pffs","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Humana","plan_name":"Medicare C Humana Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Meridian","plan_name":"Medicare C Meridan Complete Mmai","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Molina","plan_name":"Medicare C Molina Healthcare Mmai","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Unitedhealthcare","plan_name":"Medicare C Unitedhealthcare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Wellcare","plan_name":"Medicare C Wellcare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Railroad","plan_name":"Medicare Railroad A And B","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc","plan_name":"Uhc Umr","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Uhc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Va Community Care Network","plan_name":"Va Community Care Network","description":"The modified price is presented in the standard charge value."}]},{"description":"Clia waived test","code":"QW","modifier_payer_information":[{"payer_name":"Aetna Consociate","plan_name":"Aetna Asa Consociate","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Inc","plan_name":"Aetna","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Inc","plan_name":"Aetna Exchange Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Soi","plan_name":"Aetna Soi","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs Hmoi Osfhealthcare Central","plan_name":"Bcbs Hmo Osf 476 C Blue Precision","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Bce","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Bco","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Bcs","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il Osf Employee","plan_name":"Bcbs Ppo Osf Il Locations","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il Soi","plan_name":"Blue Choice Soi Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caterpillar Bcbs","plan_name":"Caterpillar Bcbs","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caterpillar Uhc","plan_name":"Caterpillar Uhc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance","plan_name":"Health Alliance Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance","plan_name":"Health Alliance Marketplace","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance","plan_name":"Health Alliance Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Aetna Better Health","plan_name":"Aetna Better Health Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Illinois","plan_name":"Medicaid Illinois","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Meridian Health Plan","plan_name":"Meridian Medicaid Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Molina","plan_name":"Molina Healthcare Of Il Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"Medicare Part A","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"Medicare Part A And B","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Aetna","plan_name":"Medicare C Aetna","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Aetna Better Health","plan_name":"Medicare C Aetna Better Health Mmai","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Bcbs Il Mmai","plan_name":"Medicare C Bcbs Il Mmai","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Bcbs Il Out Of State","plan_name":"Medicare C Bcbs Il Out Of State","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Bcbs Ppo","plan_name":"Medicare C Bcbs Il Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Health Alliance","plan_name":"Medicare C Health Alliance Hmo Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Humana","plan_name":"Medicare C Humana Hmo/Gold Plus","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Humana","plan_name":"Medicare C Humana Pffs","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Humana","plan_name":"Medicare C Humana Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Meridian","plan_name":"Medicare C Meridan Complete Mmai","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Molina","plan_name":"Medicare C Molina Healthcare Mmai","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Unitedhealthcare","plan_name":"Medicare C Unitedhealthcare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Wellcare","plan_name":"Medicare C Wellcare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Railroad","plan_name":"Medicare Railroad A And B","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc","plan_name":"Uhc Umr","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Uhc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Va Community Care Network","plan_name":"Va Community Care Network","description":"The modified price is presented in the standard charge value."}]},{"description":"Distinct Procedural Service","code":"59","modifier_payer_information":[{"payer_name":"Aetna Consociate","plan_name":"Aetna Asa Consociate","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Inc","plan_name":"Aetna","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Inc","plan_name":"Aetna Exchange Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Soi","plan_name":"Aetna Soi","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs Hmoi Osfhealthcare Central","plan_name":"Bcbs Hmo Osf 476 C Blue Precision","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Bce","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Bco","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Bcs","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il Osf Employee","plan_name":"Bcbs Ppo Osf Il Locations","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il Soi","plan_name":"Blue Choice Soi Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caterpillar Bcbs","plan_name":"Caterpillar Bcbs","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caterpillar Uhc","plan_name":"Caterpillar Uhc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance","plan_name":"Health Alliance Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance","plan_name":"Health Alliance Marketplace","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance","plan_name":"Health Alliance Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Aetna Better Health","plan_name":"Aetna Better Health Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Illinois","plan_name":"Medicaid Illinois","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Meridian Health Plan","plan_name":"Meridian Medicaid Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Molina","plan_name":"Molina Healthcare Of Il Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"Medicare Part A","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"Medicare Part A And B","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Aetna","plan_name":"Medicare C Aetna","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Aetna Better Health","plan_name":"Medicare C Aetna Better Health Mmai","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Bcbs Il Mmai","plan_name":"Medicare C Bcbs Il Mmai","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Bcbs Il Out Of State","plan_name":"Medicare C Bcbs Il Out Of State","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Bcbs Ppo","plan_name":"Medicare C Bcbs Il Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Health Alliance","plan_name":"Medicare C Health Alliance Hmo Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Humana","plan_name":"Medicare C Humana Hmo/Gold Plus","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Humana","plan_name":"Medicare C Humana Pffs","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Humana","plan_name":"Medicare C Humana Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Meridian","plan_name":"Medicare C Meridan Complete Mmai","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Molina","plan_name":"Medicare C Molina Healthcare Mmai","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Unitedhealthcare","plan_name":"Medicare C Unitedhealthcare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Wellcare","plan_name":"Medicare C Wellcare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Railroad","plan_name":"Medicare Railroad A And B","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc","plan_name":"Uhc Umr","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Uhc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Va Community Care Network","plan_name":"Va Community Care Network","description":"The modified price is presented in the standard charge value."}]},{"description":"Bilateral Procedure","code":"50","modifier_payer_information":[{"payer_name":"Aetna Consociate","plan_name":"Aetna Asa Consociate","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Inc","plan_name":"Aetna","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Inc","plan_name":"Aetna Exchange Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Soi","plan_name":"Aetna Soi","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs Hmoi Osfhealthcare Central","plan_name":"Bcbs Hmo Osf 476 C Blue Precision","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Bce","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Bco","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Bcs","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il Osf Employee","plan_name":"Bcbs Ppo Osf Il Locations","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il Soi","plan_name":"Blue Choice Soi Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caterpillar Bcbs","plan_name":"Caterpillar Bcbs","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caterpillar Uhc","plan_name":"Caterpillar Uhc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance","plan_name":"Health Alliance Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance","plan_name":"Health Alliance Marketplace","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance","plan_name":"Health Alliance Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Aetna Better Health","plan_name":"Aetna Better Health Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Illinois","plan_name":"Medicaid Illinois","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Meridian Health Plan","plan_name":"Meridian Medicaid Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Molina","plan_name":"Molina Healthcare Of Il Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"Medicare Part A","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"Medicare Part A And B","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Aetna","plan_name":"Medicare C Aetna","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Aetna Better Health","plan_name":"Medicare C Aetna Better Health Mmai","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Bcbs Il Mmai","plan_name":"Medicare C Bcbs Il Mmai","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Bcbs Il Out Of State","plan_name":"Medicare C Bcbs Il Out Of State","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Bcbs Ppo","plan_name":"Medicare C Bcbs Il Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Health Alliance","plan_name":"Medicare C Health Alliance Hmo Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Humana","plan_name":"Medicare C Humana Hmo/Gold Plus","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Humana","plan_name":"Medicare C Humana Pffs","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Humana","plan_name":"Medicare C Humana Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Meridian","plan_name":"Medicare C Meridan Complete Mmai","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Molina","plan_name":"Medicare C Molina Healthcare Mmai","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Unitedhealthcare","plan_name":"Medicare C Unitedhealthcare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Wellcare","plan_name":"Medicare C Wellcare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Railroad","plan_name":"Medicare Railroad A And B","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc","plan_name":"Uhc Umr","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Uhc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Va Community Care Network","plan_name":"Va Community Care Network","description":"The modified price is presented in the standard charge value."}]},{"description":"Left side (used to identify procedures performed on the left side of the body)","code":"LT","modifier_payer_information":[{"payer_name":"Aetna Consociate","plan_name":"Aetna Asa Consociate","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Inc","plan_name":"Aetna","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Inc","plan_name":"Aetna Exchange Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Soi","plan_name":"Aetna Soi","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs Hmoi Osfhealthcare Central","plan_name":"Bcbs Hmo Osf 476 C Blue Precision","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Bce","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Bco","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Bcs","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il Osf Employee","plan_name":"Bcbs Ppo Osf Il Locations","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il Soi","plan_name":"Blue Choice Soi Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caterpillar Bcbs","plan_name":"Caterpillar Bcbs","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caterpillar Uhc","plan_name":"Caterpillar Uhc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance","plan_name":"Health Alliance Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance","plan_name":"Health Alliance Marketplace","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance","plan_name":"Health Alliance Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Aetna Better Health","plan_name":"Aetna Better Health Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Illinois","plan_name":"Medicaid Illinois","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Meridian Health Plan","plan_name":"Meridian Medicaid Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Molina","plan_name":"Molina Healthcare Of Il Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"Medicare Part A","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"Medicare Part A And B","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Aetna","plan_name":"Medicare C Aetna","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Aetna Better Health","plan_name":"Medicare C Aetna Better Health Mmai","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Bcbs Il Mmai","plan_name":"Medicare C Bcbs Il Mmai","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Bcbs Il Out Of State","plan_name":"Medicare C Bcbs Il Out Of State","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Bcbs Ppo","plan_name":"Medicare C Bcbs Il Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Health Alliance","plan_name":"Medicare C Health Alliance Hmo Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Humana","plan_name":"Medicare C Humana Hmo/Gold Plus","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Humana","plan_name":"Medicare C Humana Pffs","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Humana","plan_name":"Medicare C Humana Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Meridian","plan_name":"Medicare C Meridan Complete Mmai","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Molina","plan_name":"Medicare C Molina Healthcare Mmai","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Unitedhealthcare","plan_name":"Medicare C Unitedhealthcare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Wellcare","plan_name":"Medicare C Wellcare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Railroad","plan_name":"Medicare Railroad A And B","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc","plan_name":"Uhc Umr","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Uhc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Va Community Care Network","plan_name":"Va Community Care Network","description":"The modified price is presented in the standard charge value."}]},{"description":"Right side (used to identify procedures performed on the right side of the body)","code":"RT","modifier_payer_information":[{"payer_name":"Aetna Consociate","plan_name":"Aetna Asa Consociate","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Inc","plan_name":"Aetna","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Inc","plan_name":"Aetna Exchange Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Soi","plan_name":"Aetna Soi","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs Hmoi Osfhealthcare Central","plan_name":"Bcbs Hmo Osf 476 C Blue Precision","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Bce","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Bco","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Bcs","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il Osf Employee","plan_name":"Bcbs Ppo Osf Il Locations","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il Soi","plan_name":"Blue Choice Soi Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caterpillar Bcbs","plan_name":"Caterpillar Bcbs","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caterpillar Uhc","plan_name":"Caterpillar Uhc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance","plan_name":"Health Alliance Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance","plan_name":"Health Alliance Marketplace","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance","plan_name":"Health Alliance Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Aetna Better Health","plan_name":"Aetna Better Health Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Illinois","plan_name":"Medicaid Illinois","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Meridian Health Plan","plan_name":"Meridian Medicaid Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Molina","plan_name":"Molina Healthcare Of Il Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"Medicare Part A","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"Medicare Part A And B","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Aetna","plan_name":"Medicare C Aetna","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Aetna Better Health","plan_name":"Medicare C Aetna Better Health Mmai","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Bcbs Il Mmai","plan_name":"Medicare C Bcbs Il Mmai","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Bcbs Il Out Of State","plan_name":"Medicare C Bcbs Il Out Of State","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Bcbs Ppo","plan_name":"Medicare C Bcbs Il Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Health Alliance","plan_name":"Medicare C Health Alliance Hmo Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Humana","plan_name":"Medicare C Humana Hmo/Gold Plus","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Humana","plan_name":"Medicare C Humana Pffs","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Humana","plan_name":"Medicare C Humana Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Meridian","plan_name":"Medicare C Meridan Complete Mmai","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Molina","plan_name":"Medicare C Molina Healthcare Mmai","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Unitedhealthcare","plan_name":"Medicare C Unitedhealthcare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Wellcare","plan_name":"Medicare C Wellcare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Railroad","plan_name":"Medicare Railroad A And B","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc","plan_name":"Uhc Umr","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Uhc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Va Community Care Network","plan_name":"Va Community Care Network","description":"The modified price is presented in the standard charge value."}]},{"description":"Reduced Services","code":"52","modifier_payer_information":[{"payer_name":"Aetna Consociate","plan_name":"Aetna Asa Consociate","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Inc","plan_name":"Aetna","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Inc","plan_name":"Aetna Exchange Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Soi","plan_name":"Aetna Soi","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs Hmoi Osfhealthcare Central","plan_name":"Bcbs Hmo Osf 476 C Blue Precision","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Bce","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Bco","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Bcs","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il Osf Employee","plan_name":"Bcbs Ppo Osf Il Locations","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il Soi","plan_name":"Blue Choice Soi Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caterpillar Bcbs","plan_name":"Caterpillar Bcbs","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caterpillar Uhc","plan_name":"Caterpillar Uhc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance","plan_name":"Health Alliance Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance","plan_name":"Health Alliance Marketplace","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance","plan_name":"Health Alliance Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Aetna Better Health","plan_name":"Aetna Better Health Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Illinois","plan_name":"Medicaid Illinois","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Meridian Health Plan","plan_name":"Meridian Medicaid Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Molina","plan_name":"Molina Healthcare Of Il Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"Medicare Part A","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"Medicare Part A And B","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Aetna","plan_name":"Medicare C Aetna","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Aetna Better Health","plan_name":"Medicare C Aetna Better Health Mmai","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Bcbs Il Mmai","plan_name":"Medicare C Bcbs Il Mmai","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Bcbs Il Out Of State","plan_name":"Medicare C Bcbs Il Out Of State","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Bcbs Ppo","plan_name":"Medicare C Bcbs Il Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Health Alliance","plan_name":"Medicare C Health Alliance Hmo Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Humana","plan_name":"Medicare C Humana Hmo/Gold Plus","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Humana","plan_name":"Medicare C Humana Pffs","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Humana","plan_name":"Medicare C Humana Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Meridian","plan_name":"Medicare C Meridan Complete Mmai","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Molina","plan_name":"Medicare C Molina Healthcare Mmai","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Unitedhealthcare","plan_name":"Medicare C Unitedhealthcare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Wellcare","plan_name":"Medicare C Wellcare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Railroad","plan_name":"Medicare Railroad A And B","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc","plan_name":"Uhc Umr","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Uhc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Va Community Care Network","plan_name":"Va Community Care Network","description":"The modified price is presented in the standard charge value."}]},{"description":"Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional","code":"76","modifier_payer_information":[{"payer_name":"Aetna Consociate","plan_name":"Aetna Asa Consociate","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Inc","plan_name":"Aetna","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Inc","plan_name":"Aetna Exchange Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Soi","plan_name":"Aetna Soi","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs Hmoi Osfhealthcare Central","plan_name":"Bcbs Hmo Osf 476 C Blue Precision","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Bce","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Bco","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Bcs","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il Osf Employee","plan_name":"Bcbs Ppo Osf Il Locations","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il Soi","plan_name":"Blue Choice Soi Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caterpillar Bcbs","plan_name":"Caterpillar Bcbs","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caterpillar Uhc","plan_name":"Caterpillar Uhc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance","plan_name":"Health Alliance Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance","plan_name":"Health Alliance Marketplace","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance","plan_name":"Health Alliance Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Aetna Better Health","plan_name":"Aetna Better Health Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Illinois","plan_name":"Medicaid Illinois","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Meridian Health Plan","plan_name":"Meridian Medicaid Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Molina","plan_name":"Molina Healthcare Of Il Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"Medicare Part A","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"Medicare Part A And B","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Aetna","plan_name":"Medicare C Aetna","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Aetna Better Health","plan_name":"Medicare C Aetna Better Health Mmai","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Bcbs Il Mmai","plan_name":"Medicare C Bcbs Il Mmai","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Bcbs Il Out Of State","plan_name":"Medicare C Bcbs Il Out Of State","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Bcbs Ppo","plan_name":"Medicare C Bcbs Il Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Health Alliance","plan_name":"Medicare C Health Alliance Hmo Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Humana","plan_name":"Medicare C Humana Hmo/Gold Plus","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Humana","plan_name":"Medicare C Humana Pffs","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Humana","plan_name":"Medicare C Humana Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Meridian","plan_name":"Medicare C Meridan Complete Mmai","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Molina","plan_name":"Medicare C Molina Healthcare Mmai","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Unitedhealthcare","plan_name":"Medicare C Unitedhealthcare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Wellcare","plan_name":"Medicare C Wellcare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Railroad","plan_name":"Medicare Railroad A And B","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc","plan_name":"Uhc Umr","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Uhc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Va Community Care Network","plan_name":"Va Community Care Network","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient physical therapy plan of care","code":"GP","modifier_payer_information":[{"payer_name":"Aetna Consociate","plan_name":"Aetna Asa Consociate","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Inc","plan_name":"Aetna","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Inc","plan_name":"Aetna Exchange Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Soi","plan_name":"Aetna Soi","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs Hmoi Osfhealthcare Central","plan_name":"Bcbs Hmo Osf 476 C Blue Precision","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Bce","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Bco","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Bcs","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il Osf Employee","plan_name":"Bcbs Ppo Osf Il Locations","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il Soi","plan_name":"Blue Choice Soi Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caterpillar Bcbs","plan_name":"Caterpillar Bcbs","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caterpillar Uhc","plan_name":"Caterpillar Uhc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance","plan_name":"Health Alliance Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance","plan_name":"Health Alliance Marketplace","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance","plan_name":"Health Alliance Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Aetna Better Health","plan_name":"Aetna Better Health Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Illinois","plan_name":"Medicaid Illinois","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Meridian Health Plan","plan_name":"Meridian Medicaid Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Molina","plan_name":"Molina Healthcare Of Il Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"Medicare Part A","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"Medicare Part A And B","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Aetna","plan_name":"Medicare C Aetna","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Aetna Better Health","plan_name":"Medicare C Aetna Better Health Mmai","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Bcbs Il Mmai","plan_name":"Medicare C Bcbs Il Mmai","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Bcbs Il Out Of State","plan_name":"Medicare C Bcbs Il Out Of State","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Bcbs Ppo","plan_name":"Medicare C Bcbs Il Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Health Alliance","plan_name":"Medicare C Health Alliance Hmo Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Humana","plan_name":"Medicare C Humana Hmo/Gold Plus","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Humana","plan_name":"Medicare C Humana Pffs","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Humana","plan_name":"Medicare C Humana Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Meridian","plan_name":"Medicare C Meridan Complete Mmai","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Molina","plan_name":"Medicare C Molina Healthcare Mmai","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Unitedhealthcare","plan_name":"Medicare C Unitedhealthcare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Wellcare","plan_name":"Medicare C Wellcare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Railroad","plan_name":"Medicare Railroad A And B","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc","plan_name":"Uhc Umr","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Uhc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Va Community Care Network","plan_name":"Va Community Care Network","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient occupational therapy plan of care","code":"GO","modifier_payer_information":[{"payer_name":"Aetna Consociate","plan_name":"Aetna Asa Consociate","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Inc","plan_name":"Aetna","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Inc","plan_name":"Aetna Exchange Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Soi","plan_name":"Aetna Soi","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs Hmoi Osfhealthcare Central","plan_name":"Bcbs Hmo Osf 476 C Blue Precision","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Bce","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Bco","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Bcs","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il Osf Employee","plan_name":"Bcbs Ppo Osf Il Locations","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il Soi","plan_name":"Blue Choice Soi Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caterpillar Bcbs","plan_name":"Caterpillar Bcbs","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caterpillar Uhc","plan_name":"Caterpillar Uhc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance","plan_name":"Health Alliance Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance","plan_name":"Health Alliance Marketplace","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance","plan_name":"Health Alliance Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Aetna Better Health","plan_name":"Aetna Better Health Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Illinois","plan_name":"Medicaid Illinois","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Meridian Health Plan","plan_name":"Meridian Medicaid Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Molina","plan_name":"Molina Healthcare Of Il Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"Medicare Part A","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"Medicare Part A And B","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Aetna","plan_name":"Medicare C Aetna","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Aetna Better Health","plan_name":"Medicare C Aetna Better Health Mmai","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Bcbs Il Mmai","plan_name":"Medicare C Bcbs Il Mmai","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Bcbs Il Out Of State","plan_name":"Medicare C Bcbs Il Out Of State","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Bcbs Ppo","plan_name":"Medicare C Bcbs Il Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Health Alliance","plan_name":"Medicare C Health Alliance Hmo Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Humana","plan_name":"Medicare C Humana Hmo/Gold Plus","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Humana","plan_name":"Medicare C Humana Pffs","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Humana","plan_name":"Medicare C Humana Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Meridian","plan_name":"Medicare C Meridan Complete Mmai","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Molina","plan_name":"Medicare C Molina Healthcare Mmai","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Unitedhealthcare","plan_name":"Medicare C Unitedhealthcare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Wellcare","plan_name":"Medicare C Wellcare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Railroad","plan_name":"Medicare Railroad A And B","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc","plan_name":"Uhc Umr","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Uhc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Va Community Care Network","plan_name":"Va Community Care Network","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient speech language pathology plan of care","code":"GN","modifier_payer_information":[{"payer_name":"Aetna Consociate","plan_name":"Aetna Asa Consociate","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Inc","plan_name":"Aetna","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Inc","plan_name":"Aetna Exchange Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Soi","plan_name":"Aetna Soi","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs Hmoi Osfhealthcare Central","plan_name":"Bcbs Hmo Osf 476 C Blue Precision","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Bce","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Bco","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Bcs","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il","plan_name":"Bcbs Il Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il Osf Employee","plan_name":"Bcbs Ppo Osf Il Locations","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Il Soi","plan_name":"Blue Choice Soi Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caterpillar Bcbs","plan_name":"Caterpillar Bcbs","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caterpillar Uhc","plan_name":"Caterpillar Uhc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance","plan_name":"Health Alliance Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance","plan_name":"Health Alliance Marketplace","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance","plan_name":"Health Alliance Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Aetna Better Health","plan_name":"Aetna Better Health Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Illinois","plan_name":"Medicaid Illinois","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Meridian Health Plan","plan_name":"Meridian Medicaid Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Molina","plan_name":"Molina Healthcare Of Il Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"Medicare Part A","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"Medicare Part A And B","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Aetna","plan_name":"Medicare C Aetna","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Aetna Better Health","plan_name":"Medicare C Aetna Better Health Mmai","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Bcbs Il Mmai","plan_name":"Medicare C Bcbs Il Mmai","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Bcbs Il Out Of State","plan_name":"Medicare C Bcbs Il Out Of State","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Bcbs Ppo","plan_name":"Medicare C Bcbs Il Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Health Alliance","plan_name":"Medicare C Health Alliance Hmo Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Humana","plan_name":"Medicare C Humana Hmo/Gold Plus","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Humana","plan_name":"Medicare C Humana Pffs","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Humana","plan_name":"Medicare C Humana Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Meridian","plan_name":"Medicare C Meridan Complete Mmai","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Molina","plan_name":"Medicare C Molina Healthcare Mmai","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Unitedhealthcare","plan_name":"Medicare C Unitedhealthcare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare C Wellcare","plan_name":"Medicare C Wellcare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Railroad","plan_name":"Medicare Railroad A And B","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr Uhc","plan_name":"Uhc Umr","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Uhc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Va Community Care Network","plan_name":"Va Community Care Network","description":"The modified price is presented in the standard charge value."}]}]}