{"hospital_name":"OSF Healthcare System","last_updated_on":"2026-01-01","version":"3.0.0","location_name":["OSF Saint Clare Medical Center"],"hospital_address":["530 Park Avenue East, Princeton, IL 61356"],"license_information":{"license_number":"0006254","state":"IL"},"type_2_npi":["1093308439","1447843891"],"attestation":{"attestation":"To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.","confirm_attestation":true,"attester_name":"Mary Beth Brown"},"financial_aid_policy":["20% off of facility standard gross charges."],"modifier_information":[{"description":"Drug amount discarded/not administered to any patient","code":"JW","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alliance","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthlink","plan_name":"SOI OAP PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthsmart","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"OSFDAN","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Distinct Procedural Service","code":"59","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alliance","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthlink","plan_name":"SOI OAP PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthsmart","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"OSFDAN","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Repeat Clinical Diagnostic Laboratory Test","code":"91","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alliance","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthlink","plan_name":"SOI OAP PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthsmart","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"OSFDAN","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Clia waived test","code":"QW","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alliance","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthlink","plan_name":"SOI OAP PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthsmart","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"OSFDAN","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Bilateral Procedure","code":"50","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alliance","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthlink","plan_name":"SOI OAP PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthsmart","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"OSFDAN","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Left side (used to identify procedures performed on the left side of the body)","code":"LT","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alliance","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthlink","plan_name":"SOI OAP PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthsmart","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"OSFDAN","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Right side (used to identify procedures performed on the right side of the body)","code":"RT","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alliance","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthlink","plan_name":"SOI OAP PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthsmart","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"OSFDAN","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Reduced Services","code":"52","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alliance","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthlink","plan_name":"SOI OAP PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthsmart","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"OSFDAN","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional","code":"76","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alliance","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge 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value."},{"payer_name":"Multiplan","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"OSFDAN","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient physical therapy plan of care","code":"GP","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Better Health Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alliance","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Blue Choice Preferred PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Other Commercial 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Transplant Or Implant Of Heart Assist System Without Mcc","code_information":[{"code":"002","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major","code_information":[{"code":"003","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.","code_information":[{"code":"004","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Liver Transplant With Mcc Or Intestinal Transplant","code_information":[{"code":"005","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Liver Transplant Without Mcc","code_information":[{"code":"006","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lung Transplant","code_information":[{"code":"007","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simultaneous Pancreas And Kidney Transplant","code_information":[{"code":"008","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone marrow transplant","code_information":[{"code":"009","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas Transplant","code_information":[{"code":"010","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc","code_information":[{"code":"011","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc","code_information":[{"code":"012","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc","code_information":[{"code":"013","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allogeneic Bone Marrow Transplant","code_information":[{"code":"014","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Autologous Bone Marrow Transplant With Cc/Mcc","code_information":[{"code":"016","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Autologous Bone Marrow Transplant Without Cc/Mcc","code_information":[{"code":"017","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies","code_information":[{"code":"018","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simultaneous Pancreas And Kidney Transplant With Hemodialysis","code_information":[{"code":"019","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc","code_information":[{"code":"020","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc","code_information":[{"code":"021","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc","code_information":[{"code":"022","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla","code_information":[{"code":"023","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc","code_information":[{"code":"024","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures With Mcc","code_information":[{"code":"025","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures With Cc","code_information":[{"code":"026","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc","code_information":[{"code":"027","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures With Mcc","code_information":[{"code":"028","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures With Cc Or Spinal Neurostimulators","code_information":[{"code":"029","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures Without Cc/Mcc","code_information":[{"code":"030","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures With Mcc","code_information":[{"code":"031","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures With Cc","code_information":[{"code":"032","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures Without Cc/Mcc","code_information":[{"code":"033","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures With Mcc","code_information":[{"code":"034","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures With Cc","code_information":[{"code":"035","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures Without Cc/Mcc","code_information":[{"code":"036","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures With Mcc","code_information":[{"code":"037","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures With Cc","code_information":[{"code":"038","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures Without Cc/Mcc","code_information":[{"code":"039","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc","code_information":[{"code":"040","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator","code_information":[{"code":"041","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc","code_information":[{"code":"042","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hyphema","code_information":[{"code":"043","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections","code_information":[{"code":"044","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neurological eye disorders","code_information":[{"code":"045","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age >17 w CC","code_information":[{"code":"046","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age >17 w/o CC","code_information":[{"code":"047","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age 0-17","code_information":[{"code":"048","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures","code_information":[{"code":"049","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sialoadenectomy","code_information":[{"code":"050","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Salivary Gland Procedures Except Sialoadenectomy","code_information":[{"code":"051","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Disorders And Injuries With Cc/Mcc","code_information":[{"code":"052","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Disorders And Injuries Without Cc/Mcc","code_information":[{"code":"053","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nervous System Neoplasms With Mcc","code_information":[{"code":"054","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nervous System Neoplasms Without Mcc","code_information":[{"code":"055","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Degenerative Nervous System Disorders With Mcc","code_information":[{"code":"056","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Degenerative Nervous System Disorders Without Mcc","code_information":[{"code":"057","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia With Mcc","code_information":[{"code":"058","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia With Cc","code_information":[{"code":"059","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","code_information":[{"code":"060","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc","code_information":[{"code":"061","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc","code_information":[{"code":"062","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc","code_information":[{"code":"063","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","code_information":[{"code":"064","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","code_information":[{"code":"065","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":3163.21,"10th_percentile":3163.21,"90th_percentile":3163.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","code_information":[{"code":"066","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Precerebral Occlusion Without Infarction With Mcc","code_information":[{"code":"067","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Precerebral Occlusion Without Infarction Without Mcc","code_information":[{"code":"068","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transient Ischemia Without Thrombolytic","code_information":[{"code":"069","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders With Mcc","code_information":[{"code":"070","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders With Cc","code_information":[{"code":"071","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders Without Cc/Mcc","code_information":[{"code":"072","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial And Peripheral Nerve Disorders With Mcc","code_information":[{"code":"073","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial And Peripheral Nerve Disorders Without Mcc","code_information":[{"code":"074","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Meningitis With Cc/Mcc","code_information":[{"code":"075","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Meningitis Without Cc/Mcc","code_information":[{"code":"076","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy With Mcc","code_information":[{"code":"077","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy With Cc","code_information":[{"code":"078","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy Without Cc/Mcc","code_information":[{"code":"079","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nontraumatic Stupor And Coma With Mcc","code_information":[{"code":"080","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nontraumatic Stupor And Coma Without Mcc","code_information":[{"code":"081","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour With Mcc","code_information":[{"code":"082","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour With Cc","code_information":[{"code":"083","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","code_information":[{"code":"084","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour With Mcc","code_information":[{"code":"085","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour With Cc","code_information":[{"code":"086","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":3111.35,"10th_percentile":3111.35,"90th_percentile":3111.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour Without Cc/Mcc","code_information":[{"code":"087","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion With Mcc","code_information":[{"code":"088","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion With Cc","code_information":[{"code":"089","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion Without Cc/Mcc","code_information":[{"code":"090","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System With Mcc","code_information":[{"code":"091","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System With Cc","code_information":[{"code":"092","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System Without Cc/Mcc","code_information":[{"code":"093","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Mcc","code_information":[{"code":"094","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Cc","code_information":[{"code":"095","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","code_information":[{"code":"096","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc","code_information":[{"code":"097","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","code_information":[{"code":"098","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","code_information":[{"code":"099","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Seizures With Mcc","code_information":[{"code":"100","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Seizures Without Mcc","code_information":[{"code":"101","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Headaches With Mcc","code_information":[{"code":"102","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Headaches Without Mcc","code_information":[{"code":"103","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath","code_information":[{"code":"104","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath","code_information":[{"code":"105","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass w PTCA","code_information":[{"code":"106","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"107","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures","code_information":[{"code":"108","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"109","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Cardiovascular Procedures w CC","code_information":[{"code":"110","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Cardiovascular Procedures w/o CC","code_information":[{"code":"111","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"112","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Orbital Procedures With Cc/Mcc","code_information":[{"code":"113","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Orbital Procedures Without Cc/Mcc","code_information":[{"code":"114","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extraocular Procedures Except Orbit","code_information":[{"code":"115","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intraocular Procedures With Cc/Mcc","code_information":[{"code":"116","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intraocular Procedures Without Cc/Mcc","code_information":[{"code":"117","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement","code_information":[{"code":"118","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vein ligation & stripping","code_information":[{"code":"119","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other circulatory system O.R. procedures","code_information":[{"code":"120","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections With Cc/Mcc","code_information":[{"code":"121","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections Without Cc/Mcc","code_information":[{"code":"122","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neurological Eye Disorders","code_information":[{"code":"123","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of The Eye With Mcc Or Thrombolytic Agent","code_information":[{"code":"124","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of The Eye Without Mcc","code_information":[{"code":"125","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute & Subacute Endocarditis","code_information":[{"code":"126","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure & Shock","code_information":[{"code":"127","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis","code_information":[{"code":"128","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures W Cc/Mcc Or Major Device","code_information":[{"code":"129","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures W/O Cc/Mcc","code_information":[{"code":"130","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial/Facial Procedures W Cc/Mcc","code_information":[{"code":"131","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial/Facial Procedures W/O Cc/Mcc","code_information":[{"code":"132","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc","code_information":[{"code":"133","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc","code_information":[{"code":"134","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sinus And Mastoid Procedures With Cc/Mcc","code_information":[{"code":"135","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sinus And Mastoid Procedures Without Cc/Mcc","code_information":[{"code":"136","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures With Cc/Mcc","code_information":[{"code":"137","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures Without Cc/Mcc","code_information":[{"code":"138","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Salivary Gland Procedures","code_information":[{"code":"139","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures With Mcc","code_information":[{"code":"140","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures With Cc","code_information":[{"code":"141","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures Without Cc/Mcc","code_information":[{"code":"142","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc","code_information":[{"code":"143","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc","code_information":[{"code":"144","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc","code_information":[{"code":"145","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy With Mcc","code_information":[{"code":"146","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy With Cc","code_information":[{"code":"147","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc","code_information":[{"code":"148","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dysequilibrium","code_information":[{"code":"149","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Epistaxis With Mcc","code_information":[{"code":"150","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Epistaxis Without Mcc","code_information":[{"code":"151","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Otitis Media And Uri With Mcc","code_information":[{"code":"152","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Otitis Media And Uri Without Mcc","code_information":[{"code":"153","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc","code_information":[{"code":"154","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses With Cc","code_information":[{"code":"155","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc","code_information":[{"code":"156","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases With Mcc","code_information":[{"code":"157","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases With Cc","code_information":[{"code":"158","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases Without Cc/Mcc","code_information":[{"code":"159","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC","code_information":[{"code":"160","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal & Femoral Hernia Procedures Age >17 w CC","code_information":[{"code":"161","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal & Femoral Hernia Procedures Age >17 w/o CC","code_information":[{"code":"162","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures With Mcc","code_information":[{"code":"163","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures With Cc","code_information":[{"code":"164","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures Without Cc/Mcc","code_information":[{"code":"165","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures With Mcc","code_information":[{"code":"166","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures With Cc","code_information":[{"code":"167","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"168","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures w/o CC","code_information":[{"code":"169","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures w/o CC","code_information":[{"code":"171","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","code_information":[{"code":"173","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"G.I. hemorrhage w CC","code_information":[{"code":"174","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","code_information":[{"code":"175","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":9489.63,"10th_percentile":9489.63,"90th_percentile":9489.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Embolism Without Mcc","code_information":[{"code":"176","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations With Mcc","code_information":[{"code":"177","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations With Cc","code_information":[{"code":"178","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations Without Cc/Mcc","code_information":[{"code":"179","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":4811.32,"10th_percentile":4811.32,"90th_percentile":4811.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms With Mcc","code_information":[{"code":"180","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms With Cc","code_information":[{"code":"181","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms Without Cc/Mcc","code_information":[{"code":"182","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma With Mcc","code_information":[{"code":"183","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma With Cc","code_information":[{"code":"184","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma Without Cc/Mcc","code_information":[{"code":"185","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion With Mcc","code_information":[{"code":"186","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion With Cc","code_information":[{"code":"187","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion Without Cc/Mcc","code_information":[{"code":"188","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Edema And Respiratory Failure","code_information":[{"code":"189","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":4811.32,"10th_percentile":4811.32,"90th_percentile":4811.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":2362.95,"10th_percentile":2362.95,"90th_percentile":2362.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":9489.63,"10th_percentile":9489.63,"90th_percentile":9489.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Mcc","code_information":[{"code":"190","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":4809.46,"10th_percentile":4809.46,"90th_percentile":4809.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4406.8,"10th_percentile":4406.8,"90th_percentile":4406.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":6326.42,"10th_percentile":6326.42,"90th_percentile":6326.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Cc","code_information":[{"code":"191","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":9489.63,"10th_percentile":9489.63,"90th_percentile":9489.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","code_information":[{"code":"192","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":7106.16,"10th_percentile":7106.16,"90th_percentile":7106.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy With Mcc","code_information":[{"code":"193","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"1 through 10","median_amount":15115.53,"10th_percentile":15115.53,"90th_percentile":15115.53},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":11249.78,"10th_percentile":11249.78,"90th_percentile":11249.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Simple Pneumonia And Pleurisy With Cc","code_information":[{"code":"194","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":7639.5,"10th_percentile":7639.5,"90th_percentile":7639.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":6339.52,"10th_percentile":6339.52,"90th_percentile":6339.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":9299.83,"10th_percentile":9299.83,"90th_percentile":9299.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy Without Cc/Mcc","code_information":[{"code":"195","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"1 through 10","median_amount":21400.75,"10th_percentile":21400.75,"90th_percentile":21400.75},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":3163.21,"10th_percentile":3163.21,"90th_percentile":3163.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease With Mcc","code_information":[{"code":"196","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease With Cc","code_information":[{"code":"197","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease Without Cc/Mcc","code_information":[{"code":"198","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax With Mcc","code_information":[{"code":"199","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax With Cc","code_information":[{"code":"200","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax Without Cc/Mcc","code_information":[{"code":"201","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bronchitis And Asthma With Cc/Mcc","code_information":[{"code":"202","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bronchitis And Asthma Without Cc/Mcc","code_information":[{"code":"203","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Signs And Symptoms","code_information":[{"code":"204","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System Diagnoses With Mcc","code_information":[{"code":"205","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System Diagnoses Without Mcc","code_information":[{"code":"206","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":2405.66,"10th_percentile":2405.66,"90th_percentile":2405.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory System Diagnosis With Ventilator Support >96 Hours","code_information":[{"code":"207","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory System Diagnosis With Ventilator Support <=96 Hours","code_information":[{"code":"208","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complex Aortic Arch Procedures","code_information":[{"code":"209","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip & Femur Procedures Except Major Joint Age >17 w CC","code_information":[{"code":"210","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip & Femur Procedures Except Major Joint Age >17 w/o CC","code_information":[{"code":"211","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concomitant Aortic And Mitral Valve Procedures","code_information":[{"code":"212","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Abdominal Aorta With Iliac Branch Procedures","code_information":[{"code":"213","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"214","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Heart Assist System Implant","code_information":[{"code":"215","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc","code_information":[{"code":"216","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc","code_information":[{"code":"217","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc","code_information":[{"code":"218","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc","code_information":[{"code":"219","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc","code_information":[{"code":"220","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M","code_information":[{"code":"221","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc","code_information":[{"code":"222","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc","code_information":[{"code":"223","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc","code_information":[{"code":"224","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc","code_information":[{"code":"225","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc","code_information":[{"code":"226","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc","code_information":[{"code":"227","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures With Mcc","code_information":[{"code":"228","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures Without Mcc","code_information":[{"code":"229","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other cardiothoracic procedures w/o CC/MCC","code_information":[{"code":"230","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Ptca With Mcc","code_information":[{"code":"231","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Ptca Without Mcc","code_information":[{"code":"232","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc","code_information":[{"code":"233","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc","code_information":[{"code":"234","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass Without Cardiac Catheterization With Mcc","code_information":[{"code":"235","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass Without Cardiac Catheterization Without Mcc","code_information":[{"code":"236","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major cardiovasc procedures w MCC","code_information":[{"code":"237","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major cardiovasc procedures w/o MCC","code_information":[{"code":"238","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc","code_information":[{"code":"239","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc","code_information":[{"code":"240","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc","code_information":[{"code":"241","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant With Mcc","code_information":[{"code":"242","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant With Cc","code_information":[{"code":"243","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","code_information":[{"code":"244","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aicd Generator Procedures","code_information":[{"code":"245","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","code_information":[{"code":"246","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc","code_information":[{"code":"247","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","code_information":[{"code":"248","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc","code_information":[{"code":"249","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc","code_information":[{"code":"250","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","code_information":[{"code":"251","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures With Mcc","code_information":[{"code":"252","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures With Cc","code_information":[{"code":"253","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures Without Cc/Mcc","code_information":[{"code":"254","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc","code_information":[{"code":"255","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders With Cc","code_information":[{"code":"256","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc","code_information":[{"code":"257","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement With Mcc","code_information":[{"code":"258","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement Without Mcc","code_information":[{"code":"259","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement With Mcc","code_information":[{"code":"260","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement With Cc","code_information":[{"code":"261","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc","code_information":[{"code":"262","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vein Ligation And Stripping","code_information":[{"code":"263","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System O.R. Procedures","code_information":[{"code":"264","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aicd Lead Procedures","code_information":[{"code":"265","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc","code_information":[{"code":"266","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","code_information":[{"code":"267","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc","code_information":[{"code":"268","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","code_information":[{"code":"269","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures With Mcc","code_information":[{"code":"270","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures With Cc","code_information":[{"code":"271","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures Without Cc/Mcc","code_information":[{"code":"272","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous And Other Intracardiac Procedures With Mcc","code_information":[{"code":"273","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous And Other Intracardiac Procedures Without Mcc","code_information":[{"code":"274","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","code_information":[{"code":"275","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator","code_information":[{"code":"276","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Mcc","code_information":[{"code":"277","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc","code_information":[{"code":"278","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc","code_information":[{"code":"279","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Mcc","code_information":[{"code":"280","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Cc","code_information":[{"code":"281","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","code_information":[{"code":"282","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired With Mcc","code_information":[{"code":"283","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired With Cc","code_information":[{"code":"284","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired Without Cc/Mcc","code_information":[{"code":"285","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","code_information":[{"code":"286","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc","code_information":[{"code":"287","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis With Mcc","code_information":[{"code":"288","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis With Cc","code_information":[{"code":"289","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis Without Cc/Mcc","code_information":[{"code":"290","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock With Mcc","code_information":[{"code":"291","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":9489.63,"10th_percentile":9489.63,"90th_percentile":9489.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":7099.04,"10th_percentile":7099.04,"90th_percentile":7099.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":7216.98,"10th_percentile":7216.98,"90th_percentile":7216.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":4435.01,"10th_percentile":4435.01,"90th_percentile":4435.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Heart Failure And Shock With Cc","code_information":[{"code":"292","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":6652.53,"10th_percentile":6652.53,"90th_percentile":6652.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Heart Failure And Shock Without Cc/Mcc","code_information":[{"code":"293","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis With Cc/Mcc","code_information":[{"code":"294","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis Without Cc/Mcc","code_information":[{"code":"295","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained With Mcc","code_information":[{"code":"296","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained With Cc","code_information":[{"code":"297","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained Without Cc/Mcc","code_information":[{"code":"298","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders With Mcc","code_information":[{"code":"299","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders With Cc","code_information":[{"code":"300","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders Without Cc/Mcc","code_information":[{"code":"301","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Atherosclerosis With Mcc","code_information":[{"code":"302","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Atherosclerosis Without Mcc","code_information":[{"code":"303","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertension With Mcc","code_information":[{"code":"304","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertension Without Mcc","code_information":[{"code":"305","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Congenital And Valvular Disorders With Mcc","code_information":[{"code":"306","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Congenital And Valvular Disorders Without Mcc","code_information":[{"code":"307","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Mcc","code_information":[{"code":"308","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Cc","code_information":[{"code":"309","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":3163.21,"10th_percentile":3163.21,"90th_percentile":3163.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","code_information":[{"code":"310","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"1 through 10","median_amount":15086.1,"10th_percentile":15086.1,"90th_percentile":15086.1},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Angina Pectoris","code_information":[{"code":"311","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Syncope And Collapse","code_information":[{"code":"312","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":14433.96,"10th_percentile":14433.96,"90th_percentile":14433.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"1 through 10","median_amount":1504.12,"10th_percentile":1504.12,"90th_percentile":1504.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chest Pain","code_information":[{"code":"313","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":3163.21,"10th_percentile":3163.21,"90th_percentile":3163.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses With Mcc","code_information":[{"code":"314","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses With Cc","code_information":[{"code":"315","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses Without Cc/Mcc","code_information":[{"code":"316","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concomitant Left Atrial Appendage Closure And Cardiac Ablation","code_information":[{"code":"317","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy Without Intraluminal Device","code_information":[{"code":"318","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endovascular Cardiac Valve Procedures With Mcc","code_information":[{"code":"319","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endovascular Cardiac Valve Procedures Without Mcc","code_information":[{"code":"320","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","code_information":[{"code":"321","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","code_information":[{"code":"322","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","code_information":[{"code":"323","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc","code_information":[{"code":"324","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy Without Intraluminal Device","code_information":[{"code":"325","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Mcc","code_information":[{"code":"326","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Cc","code_information":[{"code":"327","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc","code_information":[{"code":"328","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures With Mcc","code_information":[{"code":"329","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures With Cc","code_information":[{"code":"330","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":7216.98,"10th_percentile":7216.98,"90th_percentile":7216.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"331","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"1 through 10","median_amount":14904.0,"10th_percentile":14904.0,"90th_percentile":14904.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection With Mcc","code_information":[{"code":"332","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection With Cc","code_information":[{"code":"333","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection Without Cc/Mcc","code_information":[{"code":"334","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis With Mcc","code_information":[{"code":"335","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":2225.0,"10th_percentile":2225.0,"90th_percentile":2225.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis With Cc","code_information":[{"code":"336","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis Without Cc/Mcc","code_information":[{"code":"337","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis With Mcc","code_information":[{"code":"338","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis With Cc","code_information":[{"code":"339","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"340","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis With Mcc","code_information":[{"code":"341","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis With Cc","code_information":[{"code":"342","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"343","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures With Mcc","code_information":[{"code":"344","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures With Cc","code_information":[{"code":"345","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"346","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures With Mcc","code_information":[{"code":"347","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures With Cc","code_information":[{"code":"348","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures Without Cc/Mcc","code_information":[{"code":"349","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures With Mcc","code_information":[{"code":"350","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures With Cc","code_information":[{"code":"351","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures Without Cc/Mcc","code_information":[{"code":"352","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral With Mcc","code_information":[{"code":"353","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral With Cc","code_information":[{"code":"354","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","code_information":[{"code":"355","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures With Mcc","code_information":[{"code":"356","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures With Cc","code_information":[{"code":"357","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"358","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc","code_information":[{"code":"359","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc","code_information":[{"code":"360","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopy & Incisional Tubal Interruption","code_information":[{"code":"361","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endoscopic Tubal Interruption","code_information":[{"code":"362","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization & Radio-Implant, for Malignancy","code_information":[{"code":"363","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization Except for Malignancy","code_information":[{"code":"364","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures","code_information":[{"code":"365","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, female reproductive system w CC","code_information":[{"code":"366","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System w/o CC","code_information":[{"code":"367","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders With Mcc","code_information":[{"code":"368","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders With Cc","code_information":[{"code":"369","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders Without Cc/Mcc","code_information":[{"code":"370","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","code_information":[{"code":"371","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","code_information":[{"code":"372","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":5477.89,"10th_percentile":5477.89,"90th_percentile":5477.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","code_information":[{"code":"373","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy With Mcc","code_information":[{"code":"374","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy With Cc","code_information":[{"code":"375","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"1 through 10","median_amount":13505.7,"10th_percentile":13505.7,"90th_percentile":13505.7},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy Without Cc/Mcc","code_information":[{"code":"376","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage With Mcc","code_information":[{"code":"377","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage With Cc","code_information":[{"code":"378","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage Without Cc/Mcc","code_information":[{"code":"379","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":3163.21,"10th_percentile":3163.21,"90th_percentile":3163.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer With Mcc","code_information":[{"code":"380","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer With Cc","code_information":[{"code":"381","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer Without Cc/Mcc","code_information":[{"code":"382","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uncomplicated Peptic Ulcer With Mcc","code_information":[{"code":"383","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uncomplicated Peptic Ulcer Without Mcc","code_information":[{"code":"384","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease With Mcc","code_information":[{"code":"385","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease With Cc","code_information":[{"code":"386","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease Without Cc/Mcc","code_information":[{"code":"387","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction With Mcc","code_information":[{"code":"388","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":9622.64,"10th_percentile":9622.64,"90th_percentile":9622.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction With Cc","code_information":[{"code":"389","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":10186.0,"10th_percentile":10186.0,"90th_percentile":10186.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction Without Cc/Mcc","code_information":[{"code":"390","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"1 through 10","median_amount":9328.95,"10th_percentile":9328.95,"90th_percentile":9328.95},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":6209.09,"10th_percentile":6209.09,"90th_percentile":6209.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","code_information":[{"code":"391","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"1 through 10","median_amount":20230.52,"10th_percentile":20230.52,"90th_percentile":20230.52},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","code_information":[{"code":"392","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":9489.63,"10th_percentile":9489.63,"90th_percentile":9489.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses With Mcc","code_information":[{"code":"393","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses With Cc","code_information":[{"code":"394","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":362.6,"10th_percentile":362.6,"90th_percentile":362.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses Without Cc/Mcc","code_information":[{"code":"395","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders Age 0-17","code_information":[{"code":"396","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures With Mcc","code_information":[{"code":"397","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures With Cc","code_information":[{"code":"398","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"1 through 10","median_amount":41266.05,"10th_percentile":41266.05,"90th_percentile":41266.05},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures Without Cc/Mcc","code_information":[{"code":"399","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"400","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & non-acute leukemia w other O.R. proc w CC","code_information":[{"code":"401","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical","code_information":[{"code":"402","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & non-acute leukemia w CC","code_information":[{"code":"403","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & Non-Acute Leukemia w/o CC","code_information":[{"code":"404","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures With Mcc","code_information":[{"code":"405","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures With Cc","code_information":[{"code":"406","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures Without Cc/Mcc","code_information":[{"code":"407","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc","code_information":[{"code":"408","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc","code_information":[{"code":"409","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc","code_information":[{"code":"410","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. With Mcc","code_information":[{"code":"411","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. With Cc","code_information":[{"code":"412","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. Without Cc/Mcc","code_information":[{"code":"413","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc","code_information":[{"code":"414","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. With Cc","code_information":[{"code":"415","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc","code_information":[{"code":"416","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","code_information":[{"code":"417","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":1860.0,"10th_percentile":1860.0,"90th_percentile":1860.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Cc","code_information":[{"code":"418","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc","code_information":[{"code":"419","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures With Mcc","code_information":[{"code":"420","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures With Cc","code_information":[{"code":"421","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures Without Cc/Mcc","code_information":[{"code":"422","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc","code_information":[{"code":"423","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures With Cc","code_information":[{"code":"424","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc","code_information":[{"code":"425","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made","code_information":[{"code":"426","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc","code_information":[{"code":"427","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc","code_information":[{"code":"428","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Cervical Spinal Fusion With Mcc","code_information":[{"code":"429","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc","code_information":[{"code":"430","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Childhood Mental Disorders","code_information":[{"code":"431","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Mcc","code_information":[{"code":"432","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Cc","code_information":[{"code":"433","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"434","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Mcc","code_information":[{"code":"435","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Cc","code_information":[{"code":"436","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":2405.66,"10th_percentile":2405.66,"90th_percentile":2405.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc","code_information":[{"code":"437","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy With Mcc","code_information":[{"code":"438","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy With Cc","code_information":[{"code":"439","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":4811.32,"10th_percentile":4811.32,"90th_percentile":4811.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3190.41,"10th_percentile":3190.41,"90th_percentile":3190.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","code_information":[{"code":"440","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","code_information":[{"code":"441","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc","code_information":[{"code":"442","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"443","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract With Mcc","code_information":[{"code":"444","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":2546.5,"10th_percentile":2546.5,"90th_percentile":2546.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract With Cc","code_information":[{"code":"445","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract Without Cc/Mcc","code_information":[{"code":"446","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody","code_information":[{"code":"447","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"448","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning & toxic Effects of Drugs Age >17 w CC","code_information":[{"code":"449","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F","code_information":[{"code":"450","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"451","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications of treatment w CC","code_information":[{"code":"452","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion With Mcc","code_information":[{"code":"453","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion With Cc","code_information":[{"code":"454","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc","code_information":[{"code":"455","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"456","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"457","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"458","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Mcc","code_information":[{"code":"459","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"460","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc","code_information":[{"code":"461","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc","code_information":[{"code":"462","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"463","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"464","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"465","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement With Mcc","code_information":[{"code":"466","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement With Cc","code_information":[{"code":"467","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement Without Cc/Mcc","code_information":[{"code":"468","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl","code_information":[{"code":"469","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","code_information":[{"code":"470","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion With Mcc","code_information":[{"code":"471","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion With Cc","code_information":[{"code":"472","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion Without Cc/Mcc","code_information":[{"code":"473","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc","code_information":[{"code":"474","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc","code_information":[{"code":"475","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc","code_information":[{"code":"476","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"477","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue With Cc","code_information":[{"code":"478","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc","code_information":[{"code":"479","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint With Mcc","code_information":[{"code":"480","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint With Cc","code_information":[{"code":"481","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","code_information":[{"code":"482","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Joint Or Limb Reattachment Procedures Of Upper Extremities","code_information":[{"code":"483","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major joint & limb reattachment proc of upper extremity w/o CC/MCC","code_information":[{"code":"484","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection With Mcc","code_information":[{"code":"485","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection With Cc","code_information":[{"code":"486","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc","code_information":[{"code":"487","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc","code_information":[{"code":"488","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","code_information":[{"code":"489","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim","code_information":[{"code":"490","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back & neck proc exc spinal fusion w/o CC/MCC","code_information":[{"code":"491","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc","code_information":[{"code":"492","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc","code_information":[{"code":"493","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc","code_information":[{"code":"494","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc","code_information":[{"code":"495","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc","code_information":[{"code":"496","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc","code_information":[{"code":"497","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures With Mcc","code_information":[{"code":"500","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures With Cc","code_information":[{"code":"501","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures Without Cc/Mcc","code_information":[{"code":"502","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures With Mcc","code_information":[{"code":"503","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures With Cc","code_information":[{"code":"504","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures Without Cc/Mcc","code_information":[{"code":"505","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Thumb Or Joint Procedures","code_information":[{"code":"506","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Shoulder Or Elbow Joint Procedures With Cc/Mcc","code_information":[{"code":"507","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc","code_information":[{"code":"508","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Arthroscopy","code_information":[{"code":"509","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc","code_information":[{"code":"510","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc","code_information":[{"code":"511","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","code_information":[{"code":"512","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","code_information":[{"code":"513","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc","code_information":[{"code":"514","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc","code_information":[{"code":"515","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc","code_information":[{"code":"516","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc","code_information":[{"code":"517","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator","code_information":[{"code":"518","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion With Cc","code_information":[{"code":"519","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc","code_information":[{"code":"520","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","code_information":[{"code":"521","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","code_information":[{"code":"522","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC","code_information":[{"code":"523","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transient ischemia","code_information":[{"code":"524","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other heart assist system implant","code_information":[{"code":"525","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"526","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 77638 | Total % of Charge: 76.7] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 3726] [Surgical-Per Diem: 3726] [ICU-Per Diem: 3726] [C-Section-Case Rate: 8606] [Normal Vaginal Delivery-Case Rate: 5057] [Nursery  Level 1- Boarder-Per Diem: 887] [Nursery  Level 2-Per Diem: 887] [Nursery  Level 3-Per Diem: 887] [Nursery  Level 4-NICU-Per Diem: 887] [Rehab-Per Diem: 1065] [Hospice-Per Diem: 533] [IP High Cost Drugs ($): 0 Charge Threshold 5540 (%BC): 62.3] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 5540 (%BC): 62.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"527","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":64.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Blue Choice Preferred Ppo","methodology":"percent of total billed charges","standard_charge_percentage":72.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":54.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Complete Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is