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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","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":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth & Throat O.R. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","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":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Procedures With Mcc","code_information":[{"code":"166","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Procedures Without Cc/Mcc","code_information":[{"code":"168","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Procedures w/o CC","code_information":[{"code":"171","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","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":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Mcc","code_information":[{"code":"190","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","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":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":73892.72,"10th_percentile":73892.72,"90th_percentile":100762.8,"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":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Procedures","code_information":[{"code":"264","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","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":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Procedures With Cc","code_information":[{"code":"357","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","code_information":[{"code":"373","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Without Cc/Mcc","code_information":[{"code":"416","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Without Cc/Mcc","code_information":[{"code":"419","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Procedures With Mcc","code_information":[{"code":"515","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Procedures With Cc","code_information":[{"code":"516","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Procedures Without Cc/Mcc","code_information":[{"code":"517","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","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":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Tendonitis, Myositis And Bursitis With Mcc","code_information":[{"code":"557","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","code_information":[{"code":"561","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc","code_information":[{"code":"578","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Procedures For Obesity With Mcc","code_information":[{"code":"619","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Procedures For Obesity Without Cc/Mcc","code_information":[{"code":"621","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System With Mcc","code_information":[{"code":"757","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W Complicating Diagnoses","code_information":[{"code":"774","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Procedures","code_information":[{"code":"776","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ectopic Pregnancy","code_information":[{"code":"777","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Threatened Abortion","code_information":[{"code":"778","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Abortion Without D&C","code_information":[{"code":"779","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"False Labor","code_information":[{"code":"780","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis With Mv >96 Hours","code_information":[{"code":"870","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","code_information":[{"code":"871","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","code_information":[{"code":"872","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Principal Diagnosis Of Mental Illness","code_information":[{"code":"876","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Adjustment Reaction And Psychosocial Dysfunction","code_information":[{"code":"880","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Depressive Neuroses","code_information":[{"code":"881","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neuroses Except Depressive","code_information":[{"code":"882","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Organic Disturbances And Intellectual Disability","code_information":[{"code":"884","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Psychoses","code_information":[{"code":"885","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Behavioral And Developmental Disorders","code_information":[{"code":"886","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Mental Disorder Diagnoses","code_information":[{"code":"887","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence, Left Ama","code_information":[{"code":"894","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy","code_information":[{"code":"895","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc","code_information":[{"code":"896","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","code_information":[{"code":"897","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries With Mcc","code_information":[{"code":"901","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries With Cc","code_information":[{"code":"902","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts For Injuries Without Cc/Mcc","code_information":[{"code":"905","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","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":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc","code_information":[{"code":"922","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft","code_information":[{"code":"927","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Procedures With Diagnoses Of Other Contact With Health Services With Mcc","code_information":[{"code":"939","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Procedures With Diagnoses Of Other Contact With Health Services With Cc","code_information":[{"code":"940","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc","code_information":[{"code":"941","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Without Mcc","code_information":[{"code":"948","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare With Cc/Mcc","code_information":[{"code":"949","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare Without Cc/Mcc","code_information":[{"code":"950","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Factors Influencing Health Status","code_information":[{"code":"951","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy For Multiple Significant Trauma","code_information":[{"code":"955","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma","code_information":[{"code":"956","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Extensive O.R. Procedures With Mcc","code_information":[{"code":"969","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Extensive O.R. Procedures Without Mcc","code_information":[{"code":"970","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition With Mcc","code_information":[{"code":"974","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition With Cc","code_information":[{"code":"975","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition Without Cc/Mcc","code_information":[{"code":"976","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Or Without Other Related Condition","code_information":[{"code":"977","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","code_information":[{"code":"981","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","code_information":[{"code":"982","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1710] [Surgical-Per Diem: 1710] [ICU-Per Diem: 1710] [CCU-Per Diem: 1710] [Rehab-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"983","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Procedures Unrelated To Principal Diagnosis With Mcc","code_information":[{"code":"987","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Choice Select","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"988","median_amount":192.99,"10th_percentile":138.77,"90th_percentile":367.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 160] [Urgent Care ($): 160] [All Other OP (%BC): 75 Maximum Reimbursement 2125]","count":"117","median_amount":58.11,"10th_percentile":44.17,"90th_percentile":437.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"2322","median_amount":198.58,"10th_percentile":157.82,"90th_percentile":371.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":58.01,"10th_percentile":50.51,"90th_percentile":1642.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Hoosier Care Connect","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":476.89,"10th_percentile":476.89,"90th_percentile":476.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Hoosier Healthwise Indiana","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"73","median_amount":198.58,"10th_percentile":157.49,"90th_percentile":281.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Observation ($): 1202] [Emergency Department ($): 602] [Urgent Care ($): 404] [Clinic Visit ($): 38] [Cardiac Rehabilitation Therapy (%BC): 76] [Cardiology (%BC): 76] [Echocardiology (%BC): 76] [EKG/ECG ($): 328] [Holter Monitor/Telemetry (%BC): 76] [EEG (%BC): 76] [Neuropsychological Testing and Biofeedback ($): 152] [Chemotherapy (%BC): 76] [Radiology ($): 119] [Ultrasound Imaging (%BC): 76] [Occupational Therapy ($): 99] [Physical Therapy ($): 99] [Resp. Services/Therapy ($): 81] [Speech Therapy ($): 99] [Pulmonary Function (%BC): 76]","count":"1 through 10","median_amount":58.01,"10th_percentile":46.0,"90th_percentile":458.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"42","median_amount":195.42,"10th_percentile":164.04,"90th_percentile":305.98,"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."}]}]},{"description":"Level 3 Type A ED Visits","code_information":[{"code":"5023","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna Better Health","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":260.62,"10th_percentile":260.62,"90th_percentile":260.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"County Care","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Hoosier Care Connect","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Hoosier Healthwise Indiana","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Observation ($): 1202] [Emergency Department ($): 602] [Urgent Care ($): 404] [Clinic Visit ($): 38] [Cardiac Rehabilitation Therapy (%BC): 76] [Cardiology (%BC): 76] [Echocardiology (%BC): 76] [EKG/ECG ($): 328] [Holter Monitor/Telemetry (%BC): 76] [EEG (%BC): 76] [Neuropsychological Testing and Biofeedback ($): 152] [Chemotherapy (%BC): 76] [Radiology ($): 119] [Ultrasound Imaging (%BC): 76] [Occupational Therapy ($): 99] [Physical Therapy ($): 99] [Resp. Services/Therapy ($): 81] [Speech Therapy ($): 99] [Pulmonary Function (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Strapping and Cast Application","code_information":[{"code":"5101","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna Better Health","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 160] [Urgent Care ($): 160] [All Other OP (%BC): 75 Maximum Reimbursement 2125]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"56","median_amount":144.81,"10th_percentile":96.54,"90th_percentile":193.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Hoosier Care Connect","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Hoosier Healthwise Indiana","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":101.35,"10th_percentile":101.35,"90th_percentile":197.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Observation ($): 1202] [Emergency Department ($): 602] [Urgent Care ($): 404] [Clinic Visit ($): 38] [Cardiac Rehabilitation Therapy (%BC): 76] [Cardiology (%BC): 76] [Echocardiology (%BC): 76] [EKG/ECG ($): 328] [Holter Monitor/Telemetry (%BC): 76] [EEG (%BC): 76] [Neuropsychological Testing and Biofeedback ($): 152] [Chemotherapy (%BC): 76] [Radiology ($): 119] [Ultrasound Imaging (%BC): 76] [Occupational Therapy ($): 99] [Physical Therapy ($): 99] [Resp. Services/Therapy ($): 81] [Speech Therapy ($): 99] [Pulmonary Function (%BC): 76]","count":"1 through 10","median_amount":366.0,"10th_percentile":366.0,"90th_percentile":366.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":197.89,"10th_percentile":197.89,"90th_percentile":197.89,"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":"Level 1 Urology and Related Services","code_information":[{"code":"5371","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna Better Health","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Choice Select","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 160] [Urgent Care ($): 160] [All Other OP (%BC): 75 Maximum Reimbursement 2125]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Hoosier Care Connect","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Hoosier Healthwise Indiana","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Observation ($): 1202] [Emergency Department ($): 602] [Urgent Care ($): 404] [Clinic Visit ($): 38] [Cardiac Rehabilitation Therapy (%BC): 76] [Cardiology (%BC): 76] [Echocardiology (%BC): 76] [EKG/ECG ($): 328] [Holter Monitor/Telemetry (%BC): 76] [EEG (%BC): 76] [Neuropsychological Testing and Biofeedback ($): 152] [Chemotherapy (%BC): 76] [Radiology ($): 119] [Ultrasound Imaging (%BC): 76] [Occupational Therapy ($): 99] [Physical Therapy ($): 99] [Resp. Services/Therapy ($): 81] [Speech Therapy ($): 99] [Pulmonary Function (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Nerve Injections","code_information":[{"code":"5442","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna Better Health","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 160] [Urgent Care ($): 160] [All Other OP (%BC): 75 Maximum Reimbursement 2125]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"24","median_amount":703.42,"10th_percentile":546.23,"90th_percentile":718.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Hoosier Care Connect","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Hoosier Healthwise Indiana","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":748.69,"10th_percentile":703.42,"90th_percentile":748.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Observation ($): 1202] [Emergency Department ($): 602] [Urgent Care ($): 404] [Clinic Visit ($): 38] [Cardiac Rehabilitation Therapy (%BC): 76] [Cardiology (%BC): 76] [Echocardiology (%BC): 76] [EKG/ECG ($): 328] [Holter Monitor/Telemetry (%BC): 76] [EEG (%BC): 76] [Neuropsychological Testing and Biofeedback ($): 152] [Chemotherapy (%BC): 76] [Radiology ($): 119] [Ultrasound Imaging (%BC): 76] [Occupational Therapy ($): 99] [Physical Therapy ($): 99] [Resp. Services/Therapy ($): 81] [Speech Therapy ($): 99] [Pulmonary Function (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Imaging without Contrast","code_information":[{"code":"5521","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna Better Health","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":219.23,"10th_percentile":192.91,"90th_percentile":665.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Choice Select","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"24","median_amount":302.08,"10th_percentile":159.36,"90th_percentile":447.41,"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":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 160] [Urgent Care ($): 160] [All Other OP (%BC): 75 Maximum Reimbursement 2125]","count":"1 through 10","median_amount":377.81,"10th_percentile":377.81,"90th_percentile":377.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"52","median_amount":214.36,"10th_percentile":164.04,"90th_percentile":460.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Hoosier Care Connect","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Hoosier Healthwise Indiana","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Observation ($): 1202] [Emergency Department ($): 602] [Urgent Care ($): 404] [Clinic Visit ($): 38] [Cardiac Rehabilitation Therapy (%BC): 76] [Cardiology (%BC): 76] [Echocardiology (%BC): 76] [EKG/ECG ($): 328] [Holter Monitor/Telemetry (%BC): 76] [EEG (%BC): 76] [Neuropsychological Testing and Biofeedback ($): 152] [Chemotherapy (%BC): 76] [Radiology ($): 119] [Ultrasound Imaging (%BC): 76] [Occupational Therapy ($): 99] [Physical Therapy ($): 99] [Resp. Services/Therapy ($): 81] [Speech Therapy ($): 99] [Pulmonary Function (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":314.64,"10th_percentile":314.64,"90th_percentile":314.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 2 Imaging without Contrast","code_information":[{"code":"5522","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna Better Health","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":249.24,"10th_percentile":237.99,"90th_percentile":611.96,"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 Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"1 through 10","median_amount":697.55,"10th_percentile":697.55,"90th_percentile":697.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Choice Select","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"14","median_amount":176.44,"10th_percentile":149.16,"90th_percentile":197.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 160] [Urgent Care ($): 160] [All Other OP (%BC): 75 Maximum Reimbursement 2125]","count":"1 through 10","median_amount":437.89,"10th_percentile":262.78,"90th_percentile":511.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"35","median_amount":202.46,"10th_percentile":164.04,"90th_percentile":247.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Hoosier Care Connect","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Hoosier Healthwise Indiana","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":237.99,"10th_percentile":237.99,"90th_percentile":237.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":172.12,"10th_percentile":172.12,"90th_percentile":172.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Observation ($): 1202] [Emergency Department ($): 602] [Urgent Care ($): 404] [Clinic Visit ($): 38] [Cardiac Rehabilitation Therapy (%BC): 76] [Cardiology (%BC): 76] [Echocardiology (%BC): 76] [EKG/ECG ($): 328] [Holter Monitor/Telemetry (%BC): 76] [EEG (%BC): 76] [Neuropsychological Testing and Biofeedback ($): 152] [Chemotherapy (%BC): 76] [Radiology ($): 119] [Ultrasound Imaging (%BC): 76] [Occupational Therapy ($): 99] [Physical Therapy ($): 99] [Resp. Services/Therapy ($): 81] [Speech Therapy ($): 99] [Pulmonary Function (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":202.46,"10th_percentile":202.46,"90th_percentile":202.46,"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."}]}]},{"description":"Level 2 Drug Administration","code_information":[{"code":"5692","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna Better Health","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":204.08,"10th_percentile":204.08,"90th_percentile":204.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"1 through 10","median_amount":950.96,"10th_percentile":950.96,"90th_percentile":950.96,"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":"Blue Choice Select","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"12","median_amount":163.21,"10th_percentile":41.36,"90th_percentile":350.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 160] [Urgent Care ($): 160] [All Other OP (%BC): 75 Maximum Reimbursement 2125]","count":"1 through 10","median_amount":175.2,"10th_percentile":141.97,"90th_percentile":207.98,"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":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"32","median_amount":141.31,"10th_percentile":58.17,"90th_percentile":270.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Hoosier Care Connect","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Hoosier Healthwise Indiana","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Observation ($): 1202] [Emergency Department ($): 602] [Urgent Care ($): 404] [Clinic Visit ($): 38] [Cardiac Rehabilitation Therapy (%BC): 76] [Cardiology (%BC): 76] [Echocardiology (%BC): 76] [EKG/ECG ($): 328] [Holter Monitor/Telemetry (%BC): 76] [EEG (%BC): 76] [Neuropsychological Testing and Biofeedback ($): 152] [Chemotherapy (%BC): 76] [Radiology ($): 119] [Ultrasound Imaging (%BC): 76] [Occupational Therapy ($): 99] [Physical Therapy ($): 99] [Resp. Services/Therapy ($): 81] [Speech Therapy ($): 99] [Pulmonary Function (%BC): 76]","count":"1 through 10","median_amount":46.0,"10th_percentile":46.0,"90th_percentile":46.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Drug Administration","code_information":[{"code":"5693","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna Better Health","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Choice Select","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 160] [Urgent Care ($): 160] [All Other OP (%BC): 75 Maximum Reimbursement 2125]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":622.79,"10th_percentile":622.79,"90th_percentile":622.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Hoosier Care Connect","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Hoosier Healthwise Indiana","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Observation ($): 1202] [Emergency Department ($): 602] [Urgent Care ($): 404] [Clinic Visit ($): 38] [Cardiac Rehabilitation Therapy (%BC): 76] [Cardiology (%BC): 76] [Echocardiology (%BC): 76] [EKG/ECG ($): 328] [Holter Monitor/Telemetry (%BC): 76] [EEG (%BC): 76] [Neuropsychological Testing and Biofeedback ($): 152] [Chemotherapy (%BC): 76] [Radiology ($): 119] [Ultrasound Imaging (%BC): 76] [Occupational Therapy ($): 99] [Physical Therapy ($): 99] [Resp. Services/Therapy ($): 81] [Speech Therapy ($): 99] [Pulmonary Function (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Diagnostic Tests and Related Services","code_information":[{"code":"5721","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna Better Health","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1563.68,"10th_percentile":1563.68,"90th_percentile":1563.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Choice Select","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 160] [Urgent Care ($): 160] [All Other OP (%BC): 75 Maximum Reimbursement 2125]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":730.56,"10th_percentile":227.08,"90th_percentile":1563.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Hoosier Care Connect","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Hoosier Healthwise Indiana","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Observation ($): 1202] [Emergency Department ($): 602] [Urgent Care ($): 404] [Clinic Visit ($): 38] [Cardiac Rehabilitation Therapy (%BC): 76] [Cardiology (%BC): 76] [Echocardiology (%BC): 76] [EKG/ECG ($): 328] [Holter Monitor/Telemetry (%BC): 76] [EEG (%BC): 76] [Neuropsychological Testing and Biofeedback ($): 152] [Chemotherapy (%BC): 76] [Radiology ($): 119] [Ultrasound Imaging (%BC): 76] [Occupational Therapy ($): 99] [Physical Therapy ($): 99] [Resp. Services/Therapy ($): 81] [Speech Therapy ($): 99] [Pulmonary Function (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1476.25,"10th_percentile":1476.25,"90th_percentile":1476.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 4 Diagnostic Tests and Related Services","code_information":[{"code":"5724","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna Better Health","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Choice Select","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":185.63,"10th_percentile":185.63,"90th_percentile":185.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 160] [Urgent Care ($): 160] [All Other OP (%BC): 75 Maximum Reimbursement 2125]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":273.79,"10th_percentile":273.79,"90th_percentile":273.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Hoosier Care Connect","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Hoosier Healthwise Indiana","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Observation ($): 1202] [Emergency Department ($): 602] [Urgent Care ($): 404] [Clinic Visit ($): 38] [Cardiac Rehabilitation Therapy (%BC): 76] [Cardiology (%BC): 76] [Echocardiology (%BC): 76] [EKG/ECG ($): 328] [Holter Monitor/Telemetry (%BC): 76] [EEG (%BC): 76] [Neuropsychological Testing and Biofeedback ($): 152] [Chemotherapy (%BC): 76] [Radiology ($): 119] [Ultrasound Imaging (%BC): 76] [Occupational Therapy ($): 99] [Physical Therapy ($): 99] [Resp. Services/Therapy ($): 81] [Speech Therapy ($): 99] [Pulmonary Function (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Minor Procedures","code_information":[{"code":"5732","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna Better Health","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":192.99,"10th_percentile":185.28,"90th_percentile":217.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 160] [Urgent Care ($): 160] [All Other OP (%BC): 75 Maximum Reimbursement 2125]","count":"1 through 10","median_amount":637.46,"10th_percentile":637.46,"90th_percentile":649.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"57","median_amount":164.04,"10th_percentile":157.49,"90th_percentile":219.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Hoosier Care Connect","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Hoosier Healthwise Indiana","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":244.48,"10th_percentile":244.48,"90th_percentile":244.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":211.57,"10th_percentile":211.57,"90th_percentile":211.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Observation ($): 1202] [Emergency Department ($): 602] [Urgent Care ($): 404] [Clinic Visit ($): 38] [Cardiac Rehabilitation Therapy (%BC): 76] [Cardiology (%BC): 76] [Echocardiology (%BC): 76] [EKG/ECG ($): 328] [Holter Monitor/Telemetry (%BC): 76] [EEG (%BC): 76] [Neuropsychological Testing and Biofeedback ($): 152] [Chemotherapy (%BC): 76] [Radiology ($): 119] [Ultrasound Imaging (%BC): 76] [Occupational Therapy ($): 99] [Physical Therapy ($): 99] [Resp. Services/Therapy ($): 81] [Speech Therapy ($): 99] [Pulmonary Function (%BC): 76]","count":"1 through 10","median_amount":458.8,"10th_percentile":458.8,"90th_percentile":458.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Minor Procedures","code_information":[{"code":"5733","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna Better Health","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Choice Select","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 160] [Urgent Care ($): 160] [All Other OP (%BC): 75 Maximum Reimbursement 2125]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":195.6,"10th_percentile":195.6,"90th_percentile":259.63,"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":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Observation ($): 1202] [Emergency Department ($): 602] [Urgent Care ($): 404] [Clinic Visit ($): 38] [Cardiac Rehabilitation Therapy (%BC): 76] [Cardiology (%BC): 76] [Echocardiology (%BC): 76] [EKG/ECG ($): 328] [Holter Monitor/Telemetry (%BC): 76] [EEG (%BC): 76] [Neuropsychological Testing and Biofeedback ($): 152] [Chemotherapy (%BC): 76] [Radiology ($): 119] [Ultrasound Imaging (%BC): 76] [Occupational Therapy ($): 99] [Physical Therapy ($): 99] [Resp. Services/Therapy ($): 81] [Speech Therapy ($): 99] [Pulmonary Function (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Minor Procedures","code_information":[{"code":"5734","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna Better Health","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 160] [Urgent Care ($): 160] [All Other OP (%BC): 75 Maximum Reimbursement 2125]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":181.3,"10th_percentile":181.3,"90th_percentile":181.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Hoosier Care Connect","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Hoosier Healthwise Indiana","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Observation ($): 1202] [Emergency Department ($): 602] [Urgent Care ($): 404] [Clinic Visit ($): 38] [Cardiac Rehabilitation Therapy (%BC): 76] [Cardiology (%BC): 76] [Echocardiology (%BC): 76] [EKG/ECG ($): 328] [Holter Monitor/Telemetry (%BC): 76] [EEG (%BC): 76] [Neuropsychological Testing and Biofeedback ($): 152] [Chemotherapy (%BC): 76] [Radiology ($): 119] [Ultrasound Imaging (%BC): 76] [Occupational Therapy ($): 99] [Physical Therapy ($): 99] [Resp. Services/Therapy ($): 81] [Speech Therapy ($): 99] [Pulmonary Function (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Treatment","code_information":[{"code":"5791","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna Better Health","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Choice Select","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":412.56,"10th_percentile":356.89,"90th_percentile":468.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 160] [Urgent Care ($): 160] [All Other OP (%BC): 75 Maximum Reimbursement 2125]","count":"1 through 10","median_amount":368.09,"10th_percentile":368.09,"90th_percentile":653.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"15","median_amount":252.87,"10th_percentile":198.58,"90th_percentile":468.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Hoosier Care Connect","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Hoosier Healthwise Indiana","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1009.65,"10th_percentile":1009.65,"90th_percentile":1009.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Observation ($): 1202] [Emergency Department ($): 602] [Urgent Care ($): 404] [Clinic Visit ($): 38] [Cardiac Rehabilitation Therapy (%BC): 76] [Cardiology (%BC): 76] [Echocardiology (%BC): 76] [EKG/ECG ($): 328] [Holter Monitor/Telemetry (%BC): 76] [EEG (%BC): 76] [Neuropsychological Testing and Biofeedback ($): 152] [Chemotherapy (%BC): 76] [Radiology ($): 119] [Ultrasound Imaging (%BC): 76] [Occupational Therapy ($): 99] [Physical Therapy ($): 99] [Resp. Services/Therapy ($): 81] [Speech Therapy ($): 99] [Pulmonary Function (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Health and Behavior Services","code_information":[{"code":"5821","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna Better Health","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Choice Select","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"134","median_amount":192.99,"10th_percentile":179.31,"90th_percentile":289.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 160] [Urgent Care ($): 160] [All Other OP (%BC): 75 Maximum Reimbursement 2125]","count":"15","median_amount":36.96,"10th_percentile":36.96,"90th_percentile":969.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"285","median_amount":192.99,"10th_percentile":185.28,"90th_percentile":289.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Hoosier Care Connect","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Hoosier Healthwise Indiana","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":192.99,"10th_percentile":186.77,"90th_percentile":289.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":224.37,"10th_percentile":192.99,"90th_percentile":289.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Observation ($): 1202] [Emergency Department ($): 602] [Urgent Care ($): 404] [Clinic Visit ($): 38] [Cardiac Rehabilitation Therapy (%BC): 76] [Cardiology (%BC): 76] [Echocardiology (%BC): 76] [EKG/ECG ($): 328] [Holter Monitor/Telemetry (%BC): 76] [EEG (%BC): 76] [Neuropsychological Testing and Biofeedback ($): 152] [Chemotherapy (%BC): 76] [Radiology ($): 119] [Ultrasound Imaging (%BC): 76] [Occupational Therapy ($): 99] [Physical Therapy ($): 99] [Resp. Services/Therapy ($): 81] [Speech Therapy ($): 99] [Pulmonary Function (%BC): 76]","count":"1 through 10","median_amount":458.8,"10th_percentile":458.8,"90th_percentile":458.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":192.99,"10th_percentile":192.99,"90th_percentile":281.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 3 Health and Behavior Services","code_information":[{"code":"5823","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna Better Health","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"30","median_amount":194.07,"10th_percentile":186.32,"90th_percentile":211.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Choice Select","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Hoosier Care Connect","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Hoosier Healthwise Indiana","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"12","median_amount":186.02,"10th_percentile":186.02,"90th_percentile":274.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":186.02,"10th_percentile":142.7,"90th_percentile":274.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Observation ($): 1202] [Emergency Department ($): 602] [Urgent Care ($): 404] [Clinic Visit ($): 38] [Cardiac Rehabilitation Therapy (%BC): 76] [Cardiology (%BC): 76] [Echocardiology (%BC): 76] [EKG/ECG ($): 328] [Holter Monitor/Telemetry (%BC): 76] [EEG (%BC): 76] [Neuropsychological Testing and Biofeedback ($): 152] [Chemotherapy (%BC): 76] [Radiology ($): 119] [Ultrasound Imaging (%BC): 76] [Occupational Therapy ($): 99] [Physical Therapy ($): 99] [Resp. Services/Therapy ($): 81] [Speech Therapy ($): 99] [Pulmonary Function (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":186.02,"10th_percentile":142.7,"90th_percentile":274.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Covid-19 Vaccine Administration","code_information":[{"code":"9398","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna Better Health","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":213.41,"10th_percentile":185.29,"90th_percentile":223.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Choice Select","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"20","median_amount":187.48,"10th_percentile":159.36,"90th_percentile":361.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 160] [Urgent Care ($): 160] [All Other OP (%BC): 75 Maximum Reimbursement 2125]","count":"1 through 10","median_amount":704.07,"10th_percentile":704.07,"90th_percentile":704.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"43","median_amount":209.38,"10th_percentile":164.7,"90th_percentile":307.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Hoosier Care Connect","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Hoosier Healthwise Indiana","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":271.95,"10th_percentile":271.95,"90th_percentile":271.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Observation ($): 1202] [Emergency Department ($): 602] [Urgent Care ($): 404] [Clinic Visit ($): 38] [Cardiac Rehabilitation Therapy (%BC): 76] [Cardiology (%BC): 76] [Echocardiology (%BC): 76] [EKG/ECG ($): 328] [Holter Monitor/Telemetry (%BC): 76] [EEG (%BC): 76] [Neuropsychological Testing and Biofeedback ($): 152] [Chemotherapy (%BC): 76] [Radiology ($): 119] [Ultrasound Imaging (%BC): 76] [Occupational Therapy ($): 99] [Physical Therapy ($): 99] [Resp. Services/Therapy ($): 81] [Speech Therapy ($): 99] [Pulmonary Function (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-OPPS Clinic Services","code_information":[{"code":"N700","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna Better Health","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"90","median_amount":198.85,"10th_percentile":157.82,"90th_percentile":262.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"1 through 10","median_amount":547.12,"10th_percentile":309.47,"90th_percentile":806.83,"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":"Blue Choice Select","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"407","median_amount":190.65,"10th_percentile":10.49,"90th_percentile":256.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 160] [Urgent Care ($): 160] [All Other OP (%BC): 75 Maximum Reimbursement 2125]","count":"19","median_amount":271.69,"10th_percentile":148.97,"90th_percentile":271.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1001","median_amount":195.6,"10th_percentile":157.82,"90th_percentile":262.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Hoosier Care Connect","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":435.96,"10th_percentile":435.96,"90th_percentile":435.96,"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":"Hoosier Healthwise Indiana","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":40.8,"10th_percentile":40.8,"90th_percentile":40.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"26","median_amount":198.58,"10th_percentile":164.04,"90th_percentile":243.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"37","median_amount":202.46,"10th_percentile":164.04,"90th_percentile":252.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Observation ($): 1202] [Emergency Department ($): 602] [Urgent Care ($): 404] [Clinic Visit ($): 38] [Cardiac Rehabilitation Therapy (%BC): 76] [Cardiology (%BC): 76] [Echocardiology (%BC): 76] [EKG/ECG ($): 328] [Holter Monitor/Telemetry (%BC): 76] [EEG (%BC): 76] [Neuropsychological Testing and Biofeedback ($): 152] [Chemotherapy (%BC): 76] [Radiology ($): 119] [Ultrasound Imaging (%BC): 76] [Occupational Therapy ($): 99] [Physical Therapy ($): 99] [Resp. Services/Therapy ($): 81] [Speech Therapy ($): 99] [Pulmonary Function (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"24","median_amount":195.42,"10th_percentile":164.04,"90th_percentile":243.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Clinical Diagnostic Lab Services","code_information":[{"code":"N800","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna Better Health","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"70","median_amount":210.48,"10th_percentile":149.16,"90th_percentile":703.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"1 through 10","median_amount":622.35,"10th_percentile":574.29,"90th_percentile":1406.64,"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":"Blue Choice Select","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"384","median_amount":193.85,"10th_percentile":143.2,"90th_percentile":486.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 160] [Urgent Care ($): 160] [All Other OP (%BC): 75 Maximum Reimbursement 2125]","count":"66","median_amount":44.17,"10th_percentile":44.17,"90th_percentile":352.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"730","median_amount":201.92,"10th_percentile":149.16,"90th_percentile":587.98,"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":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":58.01,"10th_percentile":50.51,"90th_percentile":1642.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Hoosier Care Connect","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Hoosier Healthwise Indiana","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":53.79,"10th_percentile":50.51,"90th_percentile":499.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"11","median_amount":164.04,"10th_percentile":45.0,"90th_percentile":201.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"17","median_amount":193.85,"10th_percentile":157.82,"90th_percentile":394.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Observation ($): 1202] [Emergency Department ($): 602] [Urgent Care ($): 404] [Clinic Visit ($): 38] [Cardiac Rehabilitation Therapy (%BC): 76] [Cardiology (%BC): 76] [Echocardiology (%BC): 76] [EKG/ECG ($): 328] [Holter Monitor/Telemetry (%BC): 76] [EEG (%BC): 76] [Neuropsychological Testing and Biofeedback ($): 152] [Chemotherapy (%BC): 76] [Radiology ($): 119] [Ultrasound Imaging (%BC): 76] [Occupational Therapy ($): 99] [Physical Therapy ($): 99] [Resp. Services/Therapy ($): 81] [Speech Therapy ($): 99] [Pulmonary Function (%BC): 76]","count":"1 through 10","median_amount":58.01,"10th_percentile":55.3,"90th_percentile":58.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":179.46,"10th_percentile":164.04,"90th_percentile":243.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Therapy Services","code_information":[{"code":"N801","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna Better Health","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"122","median_amount":96.54,"10th_percentile":96.54,"90th_percentile":610.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"1 through 10","median_amount":452.81,"10th_percentile":128.48,"90th_percentile":2079.6,"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":"Blue Choice Select","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"547","median_amount":96.93,"10th_percentile":96.54,"90th_percentile":610.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 160] [Urgent Care ($): 160] [All Other OP (%BC): 75 Maximum Reimbursement 2125]","count":"46","median_amount":575.27,"10th_percentile":212.61,"90th_percentile":1150.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1694","median_amount":144.81,"10th_percentile":96.54,"90th_percentile":610.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Hoosier Care Connect","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Hoosier Healthwise Indiana","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"33","median_amount":312.56,"10th_percentile":96.54,"90th_percentile":610.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"46","median_amount":96.54,"10th_percentile":96.54,"90th_percentile":610.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Observation ($): 1202] [Emergency Department ($): 602] [Urgent Care ($): 404] [Clinic Visit ($): 38] [Cardiac Rehabilitation Therapy (%BC): 76] [Cardiology (%BC): 76] [Echocardiology (%BC): 76] [EKG/ECG ($): 328] [Holter Monitor/Telemetry (%BC): 76] [EEG (%BC): 76] [Neuropsychological Testing and Biofeedback ($): 152] [Chemotherapy (%BC): 76] [Radiology ($): 119] [Ultrasound Imaging (%BC): 76] [Occupational Therapy ($): 99] [Physical Therapy ($): 99] [Resp. Services/Therapy ($): 81] [Speech Therapy ($): 99] [Pulmonary Function (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"24","median_amount":303.73,"10th_percentile":96.54,"90th_percentile":610.01,"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":"Non-covered Services","code_information":[{"code":"N900","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna Better Health","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"17","median_amount":253.18,"10th_percentile":164.04,"90th_percentile":897.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"1 through 10","median_amount":733.07,"10th_percentile":733.07,"90th_percentile":733.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Choice Select","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"93","median_amount":162.42,"10th_percentile":77.87,"90th_percentile":197.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 160] [Urgent Care ($): 160] [All Other OP (%BC): 75 Maximum Reimbursement 2125]","count":"1 through 10","median_amount":207.98,"10th_percentile":207.98,"90th_percentile":207.98,"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":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"309","median_amount":164.04,"10th_percentile":157.49,"90th_percentile":897.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Hoosier Care Connect","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Hoosier Healthwise Indiana","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":262.79,"10th_percentile":262.79,"90th_percentile":897.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"18","median_amount":164.04,"10th_percentile":157.49,"90th_percentile":897.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Observation ($): 1202] [Emergency Department ($): 602] [Urgent Care ($): 404] [Clinic Visit ($): 38] [Cardiac Rehabilitation Therapy (%BC): 76] [Cardiology (%BC): 76] [Echocardiology (%BC): 76] [EKG/ECG ($): 328] [Holter Monitor/Telemetry (%BC): 76] [EEG (%BC): 76] [Neuropsychological Testing and Biofeedback ($): 152] [Chemotherapy (%BC): 76] [Radiology ($): 119] [Ultrasound Imaging (%BC): 76] [Occupational Therapy ($): 99] [Physical Therapy ($): 99] [Resp. Services/Therapy ($): 81] [Speech Therapy ($): 99] [Pulmonary Function (%BC): 76]","count":"1 through 10","median_amount":46.0,"10th_percentile":46.0,"90th_percentile":46.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":990.19,"10th_percentile":990.19,"90th_percentile":990.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Packaged Services","code_information":[{"code":"N902","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna Better Health","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Choice Select","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":144.9,"10th_percentile":144.9,"90th_percentile":164.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 160] [Urgent Care ($): 160] [All Other OP (%BC): 75 Maximum Reimbursement 2125]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":164.04,"10th_percentile":157.82,"90th_percentile":923.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Hoosier Care Connect","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Hoosier Healthwise Indiana","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Observation ($): 1202] [Emergency Department ($): 602] [Urgent Care ($): 404] [Clinic Visit ($): 38] [Cardiac Rehabilitation Therapy (%BC): 76] [Cardiology (%BC): 76] [Echocardiology (%BC): 76] [EKG/ECG ($): 328] [Holter Monitor/Telemetry (%BC): 76] [EEG (%BC): 76] [Neuropsychological Testing and Biofeedback ($): 152] [Chemotherapy (%BC): 76] [Radiology ($): 119] [Ultrasound Imaging (%BC): 76] [Occupational Therapy ($): 99] [Physical Therapy ($): 99] [Resp. Services/Therapy ($): 81] [Speech Therapy ($): 99] [Pulmonary Function (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Influenza Vaccines & Pneumococcal Pneumonia Vaccines","code_information":[{"code":"N903","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna Better Health","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":228.88,"10th_percentile":228.88,"90th_percentile":228.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Choice Select","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 160] [Urgent Care ($): 160] [All Other OP (%BC): 75 Maximum Reimbursement 2125]","count":"1 through 10","median_amount":207.98,"10th_percentile":207.98,"90th_percentile":207.98,"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":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"16","median_amount":207.95,"10th_percentile":26.69,"90th_percentile":1290.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Hoosier Care Connect","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":476.89,"10th_percentile":476.89,"90th_percentile":476.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Hoosier Healthwise Indiana","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Observation ($): 1202] [Emergency Department ($): 602] [Urgent Care ($): 404] [Clinic Visit ($): 38] [Cardiac Rehabilitation Therapy (%BC): 76] [Cardiology (%BC): 76] [Echocardiology (%BC): 76] [EKG/ECG ($): 328] [Holter Monitor/Telemetry (%BC): 76] [EEG (%BC): 76] [Neuropsychological Testing and Biofeedback ($): 152] [Chemotherapy (%BC): 76] [Radiology ($): 119] [Ultrasound Imaging (%BC): 76] [Occupational Therapy ($): 99] [Physical Therapy ($): 99] [Resp. Services/Therapy ($): 81] [Speech Therapy ($): 99] [Pulmonary Function (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Not Recognized by OPPS","code_information":[{"code":"N905","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna Better Health","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":201.92,"10th_percentile":201.92,"90th_percentile":201.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"1 through 10","median_amount":511.19,"10th_percentile":511.19,"90th_percentile":511.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Choice Select","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"28","median_amount":193.85,"10th_percentile":143.2,"90th_percentile":201.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 160] [Urgent Care ($): 160] [All Other OP (%BC): 75 Maximum Reimbursement 2125]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"15","median_amount":201.92,"10th_percentile":149.16,"90th_percentile":201.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Hoosier Care Connect","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Hoosier Healthwise Indiana","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":40.8,"10th_percentile":40.8,"90th_percentile":40.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":201.92,"10th_percentile":201.92,"90th_percentile":201.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":193.85,"10th_percentile":193.85,"90th_percentile":193.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Observation ($): 1202] [Emergency Department ($): 602] [Urgent Care ($): 404] [Clinic Visit ($): 38] [Cardiac Rehabilitation Therapy (%BC): 76] [Cardiology (%BC): 76] [Echocardiology (%BC): 76] [EKG/ECG ($): 328] [Holter Monitor/Telemetry (%BC): 76] [EEG (%BC): 76] [Neuropsychological Testing and Biofeedback ($): 152] [Chemotherapy (%BC): 76] [Radiology ($): 119] [Ultrasound Imaging (%BC): 76] [Occupational Therapy ($): 99] [Physical Therapy ($): 99] [Resp. Services/Therapy ($): 81] [Speech Therapy ($): 99] [Pulmonary Function (%BC): 76]","count":"1 through 10","median_amount":46.0,"10th_percentile":46.0,"90th_percentile":46.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Not Billable to FI","code_information":[{"code":"N907","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna Better Health","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs Illinois","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer has not provided their contracts and we are working with them to complete the information.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Choice Select","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Emergency Department ($): 160] [Urgent Care ($): 160] [All Other OP (%BC): 75 Maximum Reimbursement 2125]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Cook County Government","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"County Care","plan_name":"Government","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1378.51,"10th_percentile":345.12,"90th_percentile":2111.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Hoosier Care Connect","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Hoosier Healthwise Indiana","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian Illinois","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":231.6,"10th_percentile":231.6,"90th_percentile":231.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Observation ($): 1202] [Emergency Department ($): 602] [Urgent Care ($): 404] [Clinic Visit ($): 38] [Cardiac Rehabilitation Therapy (%BC): 76] [Cardiology (%BC): 76] [Echocardiology (%BC): 76] [EKG/ECG ($): 328] [Holter Monitor/Telemetry (%BC): 76] [EEG (%BC): 76] [Neuropsychological Testing and Biofeedback ($): 152] [Chemotherapy (%BC): 76] [Radiology ($): 119] [Ultrasound Imaging (%BC): 76] [Occupational Therapy ($): 99] [Physical Therapy ($): 99] [Resp. Services/Therapy ($): 81] [Speech Therapy ($): 99] [Pulmonary Function (%BC): 76]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]}],"modifier_information":[{"description":"Distinct Procedural Service","code":"59","modifier_payer_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Cook County Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Better Health","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Choice Select","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Care Connect","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Healthwise Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."}]},{"description":"Clia waived test","code":"QW","modifier_payer_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Cook County Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Better Health","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Choice Select","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Care Connect","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Healthwise Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."}]},{"description":"Reduced Services","code":"52","modifier_payer_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Cook County Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Better Health","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Choice Select","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Care Connect","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Healthwise Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."}]},{"description":"Left side (used to identify procedures performed on the left side of the body)","code":"LT","modifier_payer_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Cook County Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Better Health","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Choice Select","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Care Connect","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Healthwise Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."}]},{"description":"Left hand, second digit","code":"F1","modifier_payer_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Cook County Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Better Health","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Choice Select","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Care Connect","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Healthwise Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."}]},{"description":"Left foot, second digit","code":"T1","modifier_payer_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Cook County Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Better Health","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Choice Select","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Care Connect","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Healthwise Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."}]},{"description":"Right side (used to identify procedures performed on the right side of the body)","code":"RT","modifier_payer_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Cook County Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Better Health","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Choice Select","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Care Connect","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Healthwise Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."}]},{"description":"Left hand, third digit","code":"F2","modifier_payer_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Cook County Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Better Health","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Choice Select","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Care Connect","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Healthwise Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."}]},{"description":"Left hand, fourth digit","code":"F3","modifier_payer_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Cook County Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Better Health","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Choice Select","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Care Connect","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Healthwise Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."}]},{"description":"Left hand, fifth digit","code":"F4","modifier_payer_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Cook County Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Better Health","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Choice Select","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Care Connect","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Healthwise Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."}]},{"description":"Right hand, thumb","code":"F5","modifier_payer_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Cook County Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Better Health","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Choice Select","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Care Connect","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Healthwise Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."}]},{"description":"Right hand, second digit","code":"F6","modifier_payer_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Cook County Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Better Health","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Choice Select","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Care Connect","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Healthwise Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."}]},{"description":"Right hand, third digit","code":"F7","modifier_payer_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Cook County Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Better Health","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Choice Select","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Care Connect","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Healthwise Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."}]},{"description":"Right hand, fourth digit","code":"F8","modifier_payer_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Cook County Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Better Health","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Choice Select","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Care Connect","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Healthwise Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."}]},{"description":"Right hand, fifth digit","code":"F9","modifier_payer_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Cook County Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Better Health","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Choice Select","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Care Connect","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Healthwise Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."}]},{"description":"Left foot, third digit","code":"T2","modifier_payer_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Cook County Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Better Health","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Choice Select","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Care Connect","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Healthwise Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."}]},{"description":"Left foot, fourth digit","code":"T3","modifier_payer_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Cook County Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Better Health","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Choice Select","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Care Connect","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Healthwise Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."}]},{"description":"Left foot, fifth digit","code":"T4","modifier_payer_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Cook County Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Better Health","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Choice Select","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Care Connect","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Healthwise Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."}]},{"description":"Right foot, great toe","code":"T5","modifier_payer_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Cook County Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Better Health","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Choice Select","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Care Connect","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Healthwise Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."}]},{"description":"Right foot, second digit","code":"T6","modifier_payer_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Cook County Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Better Health","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Choice Select","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Care Connect","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Healthwise Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."}]},{"description":"Right foot, third digit","code":"T7","modifier_payer_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Cook County Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Better Health","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Choice Select","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Care Connect","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Healthwise Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."}]},{"description":"Right foot, fourth digit","code":"T8","modifier_payer_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Cook County Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Better Health","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Choice Select","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Care Connect","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Healthwise Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."}]},{"description":"Right foot, fifth digit","code":"T9","modifier_payer_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Cook County Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Better Health","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Choice Select","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Care Connect","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Healthwise Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."}]},{"description":"Left foot, great toe","code":"TA","modifier_payer_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Cook County Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Better Health","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Choice Select","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Care Connect","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Healthwise Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."}]},{"description":"Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional","code":"76","modifier_payer_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Cook County Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Better Health","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Choice Select","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Care Connect","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Healthwise Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","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":"Bcbs Illinois","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Cook County Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Better Health","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Choice Select","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Care Connect","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Healthwise Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."}]},{"description":"State and/or federally-funded programs/services","code":"SE","modifier_payer_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Cook County Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Better Health","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Choice Select","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Care Connect","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Healthwise Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."}]},{"description":"Child/adolescent program","code":"HA","modifier_payer_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Cook County Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Better Health","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Choice Select","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Care Connect","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Healthwise Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient occupational therapy plan of care","code":"GO","modifier_payer_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Cook County Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Better Health","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Choice Select","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Care Connect","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Healthwise Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient speech language pathology plan of care","code":"GN","modifier_payer_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Cook County Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Better Health","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Choice Select","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Care Connect","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Healthwise Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."}]},{"description":"Via interactive audio and video telecommunication systems","code":"GT","modifier_payer_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Cook County Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Better Health","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Choice Select","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Care Connect","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Healthwise Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."}]},{"description":"Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System","code":"95","modifier_payer_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Cook County Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Better Health","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Choice Select","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Care Connect","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Healthwise Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."}]},{"description":"Group setting","code":"HQ","modifier_payer_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Cook County Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Better Health","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Choice Select","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Care Connect","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Healthwise Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."}]},{"description":"Early intervention/individualized family service plan (ifsp)","code":"TL","modifier_payer_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Cook County Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Better Health","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Choice Select","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Care Connect","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Healthwise Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."}]},{"description":"Services provided on behalf of the client to someone other than the client (collateral relationship)","code":"UK","modifier_payer_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Cook County Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Better Health","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Choice Select","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Care Connect","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Healthwise Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."}]},{"description":"Increased Procedural Services","code":"22","modifier_payer_information":[{"payer_name":"Bcbs Illinois","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Cook County Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthchoice Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Better Health","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Choice Select","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"County Care","plan_name":"Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthy Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Care Connect","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Hoosier Healthwise Indiana","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian Illinois","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare Healthchoice","plan_name":"Medicaid Managed Care","description":"The modified price is presented in the standard charge value."},{"payer_name":"Youthcare","plan_name":"Medicaid Hmo","description":"The modified price is presented in the standard charge value."}]}]}